Wound Diagnostics

By Martin D. Vera LVN, CWS As devoted clinicians to the field of wound management we take a responsibility to educate ourselves and others about wound etiologies and characteristics, as well as management of barriers to achieve positive outcomes. We spend a great deal of our careers learning about the most common offenders, such as pressure injuries, diabetic foot ulcers, venous stasis ulcers, arterial wounds, amputations, and traumatic wounds, to name a few. However, as our careers unfold we are faced with extra challenges, and atypical wounds are among them.

By Cheryl Carver, LPN, WCC, CWCA, CWCP, DAPWCA, FACCWS, CLTC – Wound Educator Auditing documentation has always been part of my wound nurse role in some way or another. My first experience with auditing documentation with a fine-tooth comb was while working in the hospital wound center setting as a hyperbaric oxygen technician. Back then, hyperbaric oxygen therapy was more difficult to get reimbursed, and there were a lot of Medicare appeals. I would search through stacks of documentation to find validation for the diagnosis specific to the hyperbaric oxygen therapy indication. I quickly found out how ONE word determined reimbursement, and we are not talking pennies. The documentation is either there or it isn’t. Wound care documentation also requires the same impeccable documentation. Reimbursement is driven by Centers for Medicare & Medicaid Services (CMS) guidelines. We must follow the rules, or we do not get paid.

Before the mid-1990s, venous disorders and disease were classified almost solely on clinical appearance, which failed to achieve diagnostic precision or reproducible treatment results. In response to this, the American Venous Forum developed a classification system in 1994, which was revised in 2004. This classification system has gained widespread acceptance across the clinical and medical research communities, and most published papers now use all or part of the CEAP system (defined in the next section). This system was once again updated in 2020.

by the WoundSource Editors Given the impact of infection on delayed wound healing, determining the presence of colonization and infection is imperative to achieving healed outcomes.Chronic wounds are always contaminated, and timely implementation of management and treatment interventions is a key component of the plan of care.

By the WoundSource Editors Although complex wounds typically present with clinical challenges in treatment, there are certain types of wounds that clinicians are used to facing: pressure wounds , arterial wounds, venous wounds, diabetic wounds, moisture-related wounds, end-of-life wounds, dehisced or complicated surgical wounds, and wounds of mixed etiology. However, the uncommon complex wounds are the ones often misdiagnosed or misidentified because of a lack of understanding or even ability to have them diagnosed properly. Often the rare or unusual skin lesions or ulcers require advanced diagnostic capabilities, such as the ability to perform a biopsy, tissue culture, radiological study, or other examination. So how do you know that what you’re treating is what you think you’re treating?

By the WoundSource Editors The most common type of chronic lower extremity wound is the venous ulcer, affecting 1% to 3% of the U.S. population. Chronic venous ulcers significantly impact quality of life and are a financial burden for both the patient and the health care system. In the United States, 10% to 35% of adults have chronic venous insufficiency, and 4% of adults 65 years old or older have venous ulcers. Identifying signs of venous disease early on while implementing surgical intervention, if warranted, can increase healing outcomes and decrease the recurrence of venous ulcers. Treatment of venous ulcers can include exercise, leg elevation, dressings, advanced wound care such as cellular and tissue-based products, compression therapy, medications, venous ablation, and surgical intervention.

By Emily Greenstein, APRN, CNP, CWON, FACCWS Recently I was able to attend the Spring Symposium on Advanced Wound Care (SAWC) in San Antonio, Texas. I attended many different lectures, presented, and sat on a few expert panels. The one recurring theme that kept echoing was the need to look at the whole picture. Often, as wound specialists, we get in the habit of looking just at the wound without taking into consideration the underlying comorbidities and potential causes of the wound in the first place. This got me thinking, how do I treat a new patient who comes into my wound center? I decided to put together the top five "tips" to remember to look at the whole patient, not just the hole in the patient (as originally stated by Dr. Carrie Sussman, DPT, PT).