Wound Diagnostics

By Temple University School of Podiatric Medicine Journal Review Club

The challenges of treating lower extremity wounds for podiatrists can feel more often like a marathon than a sprint. Complex and chronic wounds can add further stress on the patient and physician alike and make this marathon feel entirely uphill. In suspiciously slow-healing chronic wounds, narrowing down the specific diagnosis, the presence of a neoplasm, and/or the bacterial load analysis can drastically alter the treatment options. A punch biopsy procedure is a useful and informative diagnostic technique that can be used to address all of the previously listed concerns and further focus the treatment of such challenging wounds. Although the punch biopsy seems as though it should be a standard diagnostic tool, many providers are hesitant to use it because it is an invasive procedure. Given that the patient’s safety is always of the upmost importance in creating a treatment plan, a multicenter clinical trial was designed to observe the incidence of complications associated with performing punch biopsy procedures in chronic open wounds.

By the WoundSource Editors

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 Lydia Corum RN MSN CWCN

The times are changing in the world of wound care. There used to be a time when there were no problems with reimbursements, as long as the doctor wrote the order. Today, the Centers for Medicare & Medicaid Services (CMS) regulations confuse clinicians and make the world of healing wounds much more difficult. The changes are in the area of denials with not enough information given for choosing dressings, use of negative pressure therapy and hyperbaric oxygen therapy. Are all these changes needed? Why are these changes happening? What can hospitals and wound clinics do to make things better?

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 the WoundSource Editors

Ulcers in the lower extremities are more common in patients older than 65. Ulcerative wound types include venous, arterial, diabetic neuropathic, and pressure. To identify ulcer types, these wounds should be examined thoroughly for their distinct characteristics such as location and shape, as well as in conjunction with other patient information, to ensure an accurate diagnosis and treatment plan.

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

Wound treatment plans are frequently ineffective because of a widespread failure to identify wound etiology accurately. One study found that up to 30% of all wounds lack a differential diagnosis, and this poses a real barrier to administering effective treatments. Furthermore, recent advances in the understanding of wounds, including the use of growth factors and bioengineered tissue and the ability to grow cells in vitro, present new opportunities to provide more effective treatment. Wound bed preparation that incorporates the TIME framework (tissue management, Infection or inflammation, moisture imbalance, and edge of wound) into the A, B, C, D, E wound bed preparation care cycle can significantly increase the ability to perform the following accurately.

By the WoundSource Editors

The concept of wound bed preparation has been utilized and accepted for over two decades. Wound bed preparation techniques can only be accurately employed after a thorough and complete assessment of the wound. Poor assessments result in a negative impact of needless costs and truancy of appropriate treatments and outcomes. The goal of wound bed preparation is to provide an optimal wound healing environment. Up-to-date research in molecular science has helped evolve new technology and advanced therapies that include growth factors, growing cells in vitro, and developing bioengineered tissue. Researchers now know that the healing process involves an array of elements that require monitoring and attentiveness.

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).

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.