Measuring Wound Outcomes
Chronic cutaneous wounds include leg ulcers, pressure ulcers, and diabetic foot ulcers. Each of these conditions is difficult to heal within an acceptably short time, and to maintain as healed. Patients suffer tremendous discomfort and pain, and are often socially deprived as a result. The financial consequences of this medical problem are enormous. Chronic or nonhealing ulcers are characterized by defective remodeling of the extracellular matrix, a failure to reepithelialize, and prolonged inflammation. In order to obtain biochemical and physical information about the wound bed and the surrounding skin, different options of noninvasive and invasive measurements have been developed and tested. Monitoring of acute and chronic wounds can be performed by measuring in an objective, precise, and reproducible way and by simply adapting existing validated technologies. When speaking of cutaneous wounds, one refers to defects in the skin surface. It is generally believed that a full and correct characterization of the level of tissue damage must be carried out by analyzing 2 distinct groups of parameters: dimensional parameters and chromatic parameters. Recently, the concept of wound bed preparation has been introduced and classified according to the clinical parameters of chronic wounds. In order to monitor the different aspects of wound bed preparation, various instrumental techniques are now under investigation, allowing improved, more objective characterization of the tissue repair process. The advantage of this new scientific discipline is the ability to study living skin in real time. The main physical wound parameters that have received the most attention over the past few years in terms of outcome in wound measurement are: area and volume, color, surface pH, temperature, wound fluid analysis, odor, pain, and tissue perfusion.
The measurement of cutaneous wounds in order to detect the progression of a disease is a routine part of medical practice. Although measurement technology has evolved continuously in all fields of medicine, its direct application to cutaneous disorders has increased recently. Only in the past decade has significant research been undertaken to further develop techniques specific to examining the skin. Advances in both the technology of imaging and computer systems have greatly supported this process and improved its clinical relevance. Assessment of any wound should begin by determining the extent of the involved area. Because the extent of a wound changes dynamically, repeated systematic assessment is necessary. The total wound extent is based on the wound dimensions and the tissue level involved. The clinical evaluation of the extent of tissue involvement due to a skin lesion, and the way a lesion evolves over time, are often assessed according to the common sense and memory of the clinician. Evaluations are typically performed based on clinical experience, using very basic, low-tech equipment to make objective measurements. The determination of wound extent may be accomplished by either noninvasive or invasive technologies. Noninvasive wound assessment includes the measurement of perimeter, maximum dimensions of length, width, and depth, surface area, volume, and determination of tissue viability. A wound can be further described using various parameters, which include duration, blood flow, oxygen, hardness, inflammation, pain, and coexisting systemic factors. These parameters are clues to the definition of the cause, pathophysiology, and status of the wound, but the authors believe that a complete and detailed history and physical examination are also fundamental.
Abstract and Introduction
Abstract
Chronic cutaneous wounds include leg ulcers, pressure ulcers, and diabetic foot ulcers. Each of these conditions is difficult to heal within an acceptably short time, and to maintain as healed. Patients suffer tremendous discomfort and pain, and are often socially deprived as a result. The financial consequences of this medical problem are enormous. Chronic or nonhealing ulcers are characterized by defective remodeling of the extracellular matrix, a failure to reepithelialize, and prolonged inflammation. In order to obtain biochemical and physical information about the wound bed and the surrounding skin, different options of noninvasive and invasive measurements have been developed and tested. Monitoring of acute and chronic wounds can be performed by measuring in an objective, precise, and reproducible way and by simply adapting existing validated technologies. When speaking of cutaneous wounds, one refers to defects in the skin surface. It is generally believed that a full and correct characterization of the level of tissue damage must be carried out by analyzing 2 distinct groups of parameters: dimensional parameters and chromatic parameters. Recently, the concept of wound bed preparation has been introduced and classified according to the clinical parameters of chronic wounds. In order to monitor the different aspects of wound bed preparation, various instrumental techniques are now under investigation, allowing improved, more objective characterization of the tissue repair process. The advantage of this new scientific discipline is the ability to study living skin in real time. The main physical wound parameters that have received the most attention over the past few years in terms of outcome in wound measurement are: area and volume, color, surface pH, temperature, wound fluid analysis, odor, pain, and tissue perfusion.
Introduction
The measurement of cutaneous wounds in order to detect the progression of a disease is a routine part of medical practice. Although measurement technology has evolved continuously in all fields of medicine, its direct application to cutaneous disorders has increased recently. Only in the past decade has significant research been undertaken to further develop techniques specific to examining the skin. Advances in both the technology of imaging and computer systems have greatly supported this process and improved its clinical relevance. Assessment of any wound should begin by determining the extent of the involved area. Because the extent of a wound changes dynamically, repeated systematic assessment is necessary. The total wound extent is based on the wound dimensions and the tissue level involved. The clinical evaluation of the extent of tissue involvement due to a skin lesion, and the way a lesion evolves over time, are often assessed according to the common sense and memory of the clinician. Evaluations are typically performed based on clinical experience, using very basic, low-tech equipment to make objective measurements. The determination of wound extent may be accomplished by either noninvasive or invasive technologies. Noninvasive wound assessment includes the measurement of perimeter, maximum dimensions of length, width, and depth, surface area, volume, and determination of tissue viability. A wound can be further described using various parameters, which include duration, blood flow, oxygen, hardness, inflammation, pain, and coexisting systemic factors. These parameters are clues to the definition of the cause, pathophysiology, and status of the wound, but the authors believe that a complete and detailed history and physical examination are also fundamental.