Technological Advances in Wound Bed Measurements
Current methods for quantifying wound bed parameters rely on subjective, visual scoring by trained evaluators. Wound bed assessment is becoming a fundamental step in wound management. The objective measurement of physical and biochemical parameters related to the wound bed and the surrounding skin has increased exponentially in the last few years due to the development of new technologies and to a greater knowledge of many aspects of wound healing. The current research into chronic wound prevention, development, and treatment has led to innovations that have brought many benefits to the general management of patients. The array of medical devices under investigation for wound assessment includes the measurement of color, pH, temperature, odor, tissue perfusion, area, and volume of the wound bed. Major advantages from the use of these techniques will be in terms of standardization of parameters, data collection and comparison at different times, and objective evaluation of therapeutic protocols. As these measurement devices become more accessible to a large variety of medical specialties, there will be also other aspects to be taken in account, like the use of a controlled environment where temperature and relative humidity are monitored, the knowledge of technical aspects of the device by the user involved, and the basic knowledge of the biological aspects to be evaluated.
Chronic wounds represent a major challenge for the caregiver. Over the last few years, an increasing number of new technologies have been shown to be beneficial in wound management. These new opportunities to accelerate the tissue repair process together with a better knowledge of the pathogenetic mechanisms of chronic wounds have led to a more targeted therapeutic control of the different wound healing phases. In order to obtain biochemical and mechanical information about the wound bed and the surrounding skin, different options of noninvasive and invasive measurements have been developed and tested.
The use of instruments to measure cutaneous parameters in wound care is in an embryonic state, and doctors and nurses still rely on the use of clinical observations. Skin lesions and, especially, the way lesions evolve over time are monitored simply according to the common sense of the caregivers, who may not use updated or efficient equipment for collecting objective measurements. Monitoring of acute and chronic wounds can be performed by measuring in an objective, precise, and reproducible way and by simply adapting the existing and proven technologies to this specific matter. Today, by using a three-dimensional scanner and a digital camera, it is possible to obtain a geometric and chromatic characterization of the wound and, therefore, via a data processing software package, obtain the numerical values of a series of parameters essential to characterizing the lesion. Reproducible, objective measurements can also be taken in remote locations without the presence of wound care experts. By using telemedicine, the data can be transmitted remotely to the main reference centers where experts may assign therapies as well as monitor the lesions continuously and reliably.
Wound measurement techniques have received consistent attention in clinical practice and research through the three main areas of interest in wound care: vascular ulcers, diabetic foot ulcers, and pressure ulcers. Today, each discipline focuses on measuring the physical parameters that may contribute substantially to the development of new pathogenetic mechanisms or to the acquisition and definition of new therapeutic technologies.
Chronic ulcers may be classified into the following main categories: vascular ulcers (venous, arterial, mixed), diabetic foot ulcers, pressure ulcers, and ulcers of various etiology. Vascular ulcers represent 75 percent of all chronic ulcers in general and are divided into venous (65%) and arterial and mixed arterial-venous ulcers (10%).
Venous Ulcers
Venous ulcers may be of various sizes, mainly affect the medial surface of the limb, and may have a medium-large extension. The borders of these ulcers are irregular in shape and are sometimes difficult to record. The perilesional skin is often affected by a process called lipodermatosclerosis featuring hyperpigmentation and hardening of the skin, which becomes fragile and easily ulcerative.
Arterial Ulcers
Arterial ulcers are a consequence of an ischemic state that may affect both small and large vessels. These lesions have small dimensions with regular borders, while the perilesional skin is pale and often lacking in skin adnexa. The wound bed of these lesions, both venous and arterial, may take on various colors according to the tissue: black if the tissue is necrotic, yellow when the tissue is mostly sloughy, and various tones of red if there is a good granulation tissue. The color of the wound bed represents one of the main indicators on the state of health of the ulcer and provides clinical indications about the microbiological balance.
Diabetic Foot Ulcers
Diabetic foot ulcers are extremely aggressive and may lead to serious complications, such as amputation of the limb. They may have various dimensions, mainly in a distal position around the toes with subsequent propagation of the phlogistic process to deeper structures of the foot. Foot ulcers are at greater risk of infection and subsequent critical functioning of the limb. Pressure ulcers affect patients suffering from immobilization due to different diseases, mainly oncological. Today, a four-stage classification is the most accepted, but several limitations are present due to the difficulty in assessing of the amount of devitalized tissue.
Current methods for quantifying wound bed parameters rely on subjective, visual scoring by trained evaluators. Wound bed assessment is becoming a fundamental step in wound management. The objective measurement of physical and biochemical parameters related to the wound bed and the surrounding skin has increased exponentially in the last few years due to the development of new technologies and to a greater knowledge of many aspects of wound healing. The current research into chronic wound prevention, development, and treatment has led to innovations that have brought many benefits to the general management of patients. The array of medical devices under investigation for wound assessment includes the measurement of color, pH, temperature, odor, tissue perfusion, area, and volume of the wound bed. Major advantages from the use of these techniques will be in terms of standardization of parameters, data collection and comparison at different times, and objective evaluation of therapeutic protocols. As these measurement devices become more accessible to a large variety of medical specialties, there will be also other aspects to be taken in account, like the use of a controlled environment where temperature and relative humidity are monitored, the knowledge of technical aspects of the device by the user involved, and the basic knowledge of the biological aspects to be evaluated.
Chronic wounds represent a major challenge for the caregiver. Over the last few years, an increasing number of new technologies have been shown to be beneficial in wound management. These new opportunities to accelerate the tissue repair process together with a better knowledge of the pathogenetic mechanisms of chronic wounds have led to a more targeted therapeutic control of the different wound healing phases. In order to obtain biochemical and mechanical information about the wound bed and the surrounding skin, different options of noninvasive and invasive measurements have been developed and tested.
The use of instruments to measure cutaneous parameters in wound care is in an embryonic state, and doctors and nurses still rely on the use of clinical observations. Skin lesions and, especially, the way lesions evolve over time are monitored simply according to the common sense of the caregivers, who may not use updated or efficient equipment for collecting objective measurements. Monitoring of acute and chronic wounds can be performed by measuring in an objective, precise, and reproducible way and by simply adapting the existing and proven technologies to this specific matter. Today, by using a three-dimensional scanner and a digital camera, it is possible to obtain a geometric and chromatic characterization of the wound and, therefore, via a data processing software package, obtain the numerical values of a series of parameters essential to characterizing the lesion. Reproducible, objective measurements can also be taken in remote locations without the presence of wound care experts. By using telemedicine, the data can be transmitted remotely to the main reference centers where experts may assign therapies as well as monitor the lesions continuously and reliably.
Wound measurement techniques have received consistent attention in clinical practice and research through the three main areas of interest in wound care: vascular ulcers, diabetic foot ulcers, and pressure ulcers. Today, each discipline focuses on measuring the physical parameters that may contribute substantially to the development of new pathogenetic mechanisms or to the acquisition and definition of new therapeutic technologies.
Chronic ulcers may be classified into the following main categories: vascular ulcers (venous, arterial, mixed), diabetic foot ulcers, pressure ulcers, and ulcers of various etiology. Vascular ulcers represent 75 percent of all chronic ulcers in general and are divided into venous (65%) and arterial and mixed arterial-venous ulcers (10%).
Venous Ulcers
Venous ulcers may be of various sizes, mainly affect the medial surface of the limb, and may have a medium-large extension. The borders of these ulcers are irregular in shape and are sometimes difficult to record. The perilesional skin is often affected by a process called lipodermatosclerosis featuring hyperpigmentation and hardening of the skin, which becomes fragile and easily ulcerative.
Arterial Ulcers
Arterial ulcers are a consequence of an ischemic state that may affect both small and large vessels. These lesions have small dimensions with regular borders, while the perilesional skin is pale and often lacking in skin adnexa. The wound bed of these lesions, both venous and arterial, may take on various colors according to the tissue: black if the tissue is necrotic, yellow when the tissue is mostly sloughy, and various tones of red if there is a good granulation tissue. The color of the wound bed represents one of the main indicators on the state of health of the ulcer and provides clinical indications about the microbiological balance.
Diabetic Foot Ulcers
Diabetic foot ulcers are extremely aggressive and may lead to serious complications, such as amputation of the limb. They may have various dimensions, mainly in a distal position around the toes with subsequent propagation of the phlogistic process to deeper structures of the foot. Foot ulcers are at greater risk of infection and subsequent critical functioning of the limb. Pressure ulcers affect patients suffering from immobilization due to different diseases, mainly oncological. Today, a four-stage classification is the most accepted, but several limitations are present due to the difficulty in assessing of the amount of devitalized tissue.