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How vital is the accurate measurement of a foot ulcer or a chronic wound?

Discussion in 'Diabetic Foot & Wound Management' started by Delcam-Healthcare, Jul 30, 2010.

  1. Delcam-Healthcare

    Delcam-Healthcare Active Member


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    Well, what do people think? No doubt in your line of work you would have come across elderly or diabetes sufferers who have a slow healing wound - just how vital is the accuracy in knowing the size and magnitude of the wound and your designs with Orthotics?

    Also with the method you are using to evaluate the size effective or a guess at best? I'm sure some of you have come across tracing solutions or have trialled digital systems of documentation - how are your experiences with these?
     
  2. Tuckersm

    Tuckersm Well-Known Member

    We use photography fairly regularly, backed up with tracings on opsite flexigrid. Smaller wounds may be measured with a disposable ruler, and for depth we tend to use the Visitrak probes. We do have access to a visitrak, but find that we only use it for the really big wounds.
     
  3. Delcam-Healthcare

    Delcam-Healthcare Active Member

    Do you find fiing away these tracings for multiple patients records time consuming? Does it take around 5 minutes to measure and document each wound?

    As for the vistrak probe, does this provide enough information on the wound's progress and would the knowledge of the wound's volume be more beneficial?

    From what you are saying the surface area (at least for smaller wounds) is enough information to make an informed decision?

    Lastly would you ever consider a paperless system or is this down to the numbers of patients and the high initial cost?
     
  4. footsiegirl

    footsiegirl Active Member

    The Flexigrid is still a useful tool, despite it being time consuming and the results a little subjective - depending on the acuracy of the practitioner, however, do take photos too, as well as using a measure. How can you 'remember' the size, shape, depth and colour of a wound (and the viability of the surrounding tissues) without visual evidence?
     
  5. Delcam-Healthcare

    Delcam-Healthcare Active Member

    Yes, I'm definitely with you with visual evidence but rather than area measurements being stored on Flexigrids wouldn't it be useful to have it stored on some electronic handheld device that also made a decent guess at the volume as well? Though such a system would likely be expensive (talking in the region of £1000s) it would remove some subjectivity with the traces by having 3D data and patient records stored.

    Footsiegirl, would you ever consider such a system? And if so would the initial cost put you off? The "break even" would be more considered in saved time and having many patients (economies of scale) - as well as possibly having more detailed data resulting in faster treatment change regimes as and when required. ie you could argue the wound is proven to be not as bad and a cheaper dressing can be used if you had the appropriate evidence of the state of the wound.
     
  6. footsiegirl

    footsiegirl Active Member

    i have no need for such a device for the following reasons:

    Firstly, I wouldnt be treating a leg or foot ulcer rountinely in my work as a Foot Health Practitioner for obvious reasons- I would only have a need to measure if I discovered that a patient had a wound - which I do find from time to time, and then have to refer.

    Secondly, why use something that only "guesses" at the dimensions/volume?

    I think that an ulcer/wound assessment 'tool' is also valuable, because you can record a range of details including, pain, odour, size, shape, exudate, location, duration, ABPI, and the appearance of the wound - ie, deep, shallow, slough,epithelial, granulation,necrotic, signs of infection and so on.
     
  7. Delcam-Healthcare

    Delcam-Healthcare Active Member

    As with any measuring system its never going to be 100% accurate - I was alluding to 3D scanning technologies which are not only alot more accurate but arguably (once the technology comes along a bit) a lot faster at assessing the dimensions of the wound than manual tracing.

    As for wound assessment tools - they are useful but the critiscism they often get is the subjectivity of these and inconsistency of the systems used (albeit they are all fairly similar). Often these scores you give to things such as % of tissue or exudate types are very approximate and as many have pointed out often a simple photograph trumps any paper based system in terms of accuracy of data.

    And as you rightly pointed out you would likely refer them but it would be good if the data you were logging of the patient at the initial stage was consistent to the systems the person you were referring them to had ?
     
  8. footsiegirl

    footsiegirl Active Member

    Point taken, but I dont think it is merely a matter of finding one system better than another, often it is the case that to get a more rounded picture, a variety of tools is needed. For instance, a photograph doesnt measure the depth of a wound or take note of the odour. Neither does it record that a patient suffers with alzheimers and in incontinent - which can also result in the wound becoming contaminated.

    I agree, some uniformity is valuable...however, the trouble with anything that has a human being operating it, is that it will have an element of subjectivity or error to it- even the camera can lie - and I should know as my other half is a photographer!

    To conclude: I would undertake an assessment - that can still be recorded on a data software system - take a photograph - and measure the depth - not all methods need to be undertaken at each evaulation, but you need to start with a base line?
     
  9. Delcam-Healthcare

    Delcam-Healthcare Active Member

    Yup valid point with photography there's all sorts of problems with elevation, angle and contours of the skin!

    I feel the dimensions and infection levels are critical 'base line' variables to look out for at least from your initial point of view before passing it on for referral - I presume further detailed assessment can be done by a clinician or doctor.

    Though fundamentally its making sure the information is understood and actionable (and therefore accurate and unambiguous) by a multi disciplinary team. As its not so much the amount of information its the quality!
     
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