1. NORDIC SCIENTIFIC SYMPOSIUM 07.10.2005
NEW TOOL FOR WOUND ASSESSMENT – IMPACT ON THE CHOICE OF TREATMENT STRATEGIES
MARCUS GÜRGEN
SENIOR CONSULTANT SURGEON
OUTPATIENT WOUND CLINIC/DEPT. OF SURGERY
SØRLANDET HOSPITAL
FLEKKEFJORD / NORWAY

2. GRACE

3. IS THERE IMPROVEMENT?

4. OTHER PARAMETERS (EG pH)
WOUND ASSESSMENT
LENGTH , WIDTH, DEPTH,
AREA;
OTHER PARAMETERS (EG pH)
APPEARANCE OF
WOUND BED, WOUND
EDGES AND SURROUNDING
SKIN
WOUND ASSESSMENT
WOUND DIAGNOSIS
DOCUMENTATION
FACTORS
IMPAIRING
WOUND HEALING
PROGNOSIS
ADAPTED FROM FLANAGAN 2003, KRASNER AND RIJSWIJK 1994

5. THE ROLE OF WOUND ASSESSMENT
Reaching diagnosis
Providing baseline data to which future data can be measured
Monitoring the effect of treatment
Predict the outcome
Important to have a standardized assessment tool
”You can’t manage what you don’t measure”

6. WOUND HEALING Mechanisms providing contraction:
I= WOUND AREA
II= CONTRACTION
III= EPITHELIALIZATION
Mechanisms providing
contraction:
Fibrine drying (day 3-5)
Myofibroblasts
Factors impairing contraction:
Ischemia
Hypoproteinaemia
Old age
Infection
Necrosis
Foreign bodies
Localisation of the wound
Radiation / cytostatic or
immunocomprimising
medication
ADAPTED FROM NOCKEMANN PF: DIE CHIRURGISCHE NAHT. THIEME, STUTTGART 1980

7. THE ROLE OF WOUND ASSESSMENT IN WBP
TISSUE
MANAGEMENT
INFECTION
CONTROL
MOISTURE
BALANCE
EPIDERMAL
ADVANCEMENT
WOUND ASSESSMENT
IDENTIFY BARRIERS TO HEALING
HEALING
ASSESSMENT
TREATMENT DECISION
ADAPTED FROM MOORE 2005

8. PROGNOSTIC INDICATORS
The rate of healing in the early stages can provide information on the likelihood of total healing
Sheehan et al. 2003: diabetic ulcers (12 w)
Kantor and Margolis 2000: venous ulcers (24 w)
Kantor and Margolis 2000: Percent reduction of area from week 0 to week 4 is a significant prognostic factor
Gelfand et al. 2002: 68% of all wounds which showed 28,8% area reduction in the first 4 weeks of treatment healed within 24 weeks

9. MEASUREMENT OF WOUND AREA
One observable outcome of underlying cellular events in wound healing is contraction and migration of the epidermis over healthy granulation tissue = wound margins reaching the centre of a wound

10. METHODS Length x width (linear measurement)
Tracing and counting squares (area)
Digital planimetry (area)
Tracing using grids, scanner and equivalent software (area)
3-D-analysis using laser
Volume measurement (molding material, Kundin device)
Stereophotogrammetry
Ultrasoundscanning

11. METHODS
Schultz G, Mozingo D, Romanelli M, Claxton K. Wound healing and TIME; new concepts and scientific applications. Wound Rep Regen 2005;13(4):S1-11

12. KEEP IT SIMPLE…
… AND PRECISE!

13. DIGITAL PLANIMETRY VISITRAK™ Tracing grid is placed over the wound
Wound margins are traced on the upper layer of the grid
Grid is placed on the battery operated digital unit and transferred to the unit by retracing the perimeter with a stylus so the underlying sensor records wound perimeter

14. ADVANTAGES Area, length and width are measured
Calculation of percent area change possible
Necrotic areas can be measured
Area calculations with 94 – 98 % accuracy
Includes software for storage of data and wound healing curves
Safe to use
Easy to use
High intrarater reliability
Non-invasive
Portable
Permanent copy for patient journal
Helps to get the patient informed
Fair price

15. DISADVANTAGES Sometimes difficult to determine wound edges
Vapor on the backside of the tracing sheets

16. EXAMPLE
28,6 % area reduction after 17 days

17. MEASUREMENTS OF 92 WOUNDS VISITRAK™ VS. COUNTING SQUARES
Same area measured with counting squares and Visitrak™: 13
Counting squares
0,5 cm² cm²
7,5 cm²
Visitrak™
0,3 cm² - 130,8 cm²
7,2 cm²
%-difference
0 - 60
Mean difference = 0,78 cm²

18. WOUND BED PREPARATION INITIAL ASSESSMENT WOUND AREA A๐
CHOICE OF TREATMENT 4 W E K S
WOUND BED PREPARATION
NEW ASSESSMENT
WOUND AREA Aı
% REDUCTION A๐/Aı
20-40 %
<20 %
NO CHANGE/INCREASE
CONTINUE SAME
TREATMENT, WOUND
LIKELY TO HEAL
WITHIN 24 WEEKS
CONTINUE SAME
TREATMENT,
RE-ASSESSMENT
WITHIN 4 WEEKS
RE-ASSESSMENT
ADVANCED TREATMENT
OPTIONS
HEALING
NOT HEALING
ENDPOINT: WOUND CLOSURE

19. 27,1 cm²
Δ 43,6%
25,4 cm²
Δ 6,3%
21,4 cm²
Δ 15,8%
47,2 cm²

20. WOUND HEALING CURVES Wound healing is not a linear process
Different types of wounds heal at different rates
Data on wound healing can be obtained by regularly measuring wounds with a standardized method
Would allow better prediction of healing
PERCENTAGE OF ULCERS HEALED AFTER 4 TO 24
WEEKS OF GOOD WOUND CARE
ADAPTED FROM KANTOR J, MARGOLIS DJ. EXPECTED HEALING RATES
FOR CHRONIC WOUNDS. WOUNDS 2000; 12(8):

21. BETTER CLINICAL PRACTICE FLANAGAN 2004
IMPROVED WOUND MEASUREMENT
PREDICTION OF HEALING RATES
IMPROVED DOCUMENTATION
IMPROVED DECISION-MAKING
IMPROVED PATIENT OUTCOMES

22. CONCLUSIONS
Epidermal advancement is a parameter which is easy to measure
There is evidence that %-change of area can be used as a prognostic indicator
Wound measurement should be simple and reliable
Results of wound measurement help us to make decisions in wound treatment

23. THANK YOU!
ØVERLI

24. NIFS-SEMINAR 2006 TOPIC: ”If wounds are not healing”
WHERE: SAS Radisson Hotel, Tromsø / Norway
WHEN: February 2nd and 3rd, 2006
INFORMATION: Guro Vaagbø, Seksjon for hyperbar medisin, Haukeland Universitetssykehus, N-5021 Bergen;