Wound Documentation: How to Tell If a Wound is Healing

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by Aletha Tippett MD

We are supposed to check a wound every week and measure length, width and depth. These measurements should be getting smaller if the wound is healing, and we need to see improvement within two weeks, or have to consider that we need a different dressing on the wound. Of course, we also look at the type of tissue in the wound - granulation, slough, or necrosis - and the amount of drainage and odor. Those things can change our opinion about the wound. Maybe the wound measurements are not smaller but the wound has good granulation and shows signs of contraction - that wound is healing despite the measurements. Wound measurements can be very inaccurate. Often it depends on how the patient is positioned and who is doing the measurement. Even the same person taking measurements will not be the same every time.

Using Computerized Wound Documentation to Track Wound Healing Progress

Using a computerized picture system can help tremendously, where you mark length and width on the computer picture, then draw around the wound. This will give you good information on the size of the wound, and will give you percentage change. You can track it over time, even drawing a graph of wound change. The system we use in my facility is called Pictzar® (from M. Wendelken, New York, NY).

Another new way to monitor wound progress is with the use of an infrared camera. We are trialing that in our office using a camera with associated software from WoundVision® (WoundVision, Indianapolis, IN) and the results are wonderfully helpful. You still have your measurements, and a photograph, but you also get an infrared picture either in black and white or color that really tells you at a glance how the wound is doing. In the black and white picture, dark is cool - necrosis or lack of blood flow, or surprisingly, pyoderma gangrenosum - white can mean inflammation or infection. More than once I have been convinced of infection based on the infrared picture of white, treated the patient with antibiotics, and been very gratified by the outcome. The software with the camera can be used to compare the wound to the normal tissue and show you how close the wound is to becoming normal.

Being able to use newer wound assessment technology with cameras and computers can be very helpful in wound care, ensuring that you are progressing and meeting goals. With the infrared you are able to detect a problem before you can see it, such as a developing infection, or osteomyelitis. It can also identify deep tissue injury for you. The key for us in wound care is to be aware of innovations in the field that can help us, be open to considering them, and look for ways to use them.

About The Author
Aletha Tippett MD is a family medicine and wound care expert, founder and president of the Hope of Healing Foundation®, family physician, and international speaker on wound care.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

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How can measurement accuracy be verified between users? What differences in wound care practice have been made as a direct outcome to this new "accuracy" in wound care measuring?

Thank you for pointing out that wound measurements are often inaccurate. Hopefully good electronic systems will result in improvements. I look for good healthy tissue first, then for the wound size to decrease. If the original tissue is unhealthy, the wound may increase in size as a part of the successful healing process (as this problematic tissue is removed). Decreasing edema can also make a wound appear to be increasing in size when it is actually healing well. Also, I have found that deep wounds often do not decrease in length and width at all until they become shallower, so when only wound area is recorded, a wound that is healing well may appear, on paper, as if it is not healing at all.

Why every week? These are chronic wounds! Think of the healthcare savings and improved patient access if we move at least some (most?) of these patients to less frequent visits!

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