Christina Lindholm. Professor, PhD SRN Hon. EPUAP
Regular assessment of wounds is a prerequisite for professional documentation. Measurements are however often subjective. Evidence-based methods are desirable. Assessment of wound healing can be performed with different methodologies. Assessment not only of the area of the wound, but also volume, percentage of fibrin and necrotic tissue is fundamental to evaluate the progress or regress of healing. Tools for wound assessment include Bates-Jensen Wound Assessment Tool (BWAT), Pressure Ulcer Scale for Healing (PUSH), Sussman Wound Healing Tool (SWHT). Most common clinical practice is to measure the area by linear, perpendicular mm-ruler. For larger wounds with irregular shape, this is however not accurate, since the method is reported to overestimate the wound area. Drawing the contours of the ulcer on an acetate sheet using the “clock model” is common practice. Measurement with digital planimeter has shown superior precision compared to linear measurements . However, when volume is an issue, and when structures such as fibrin and necroses are present in the wound, no reliable and simple method has hitherto been available. Filling the wound with gel, and sucking it out and measure the gel volume has been one method, but validity of this method is not documented. Digital photography e.g. with an Iphone gives a visual picture of the presence of fibrin and necroses. However, the distance between the camera lens and the wound can bias accurate measurement. Whichever method is used, using the clock to indicate the wound´s position and different characteristics is recommended. Validity, accuracy, reliability and consistency in the practice of different methods varies, and manual skills and experience of the nurse can influence the precision of the results.
Traditional , manual (linear, perpendicular) measurement according to the clock-model and measuring fistula depth with cotton tip sond.
To-day, new digital cameras have been developed for wound assessment. Pictzar, Xotocam och Insight WoundWorks are some, which all measure area, volume and percentage of fibrin and necroses and register the wound in a three-dimensional picture. The new method is demonstrated.