Key Insights On Mapping Wounds With Ultrasound

By Martin Wendelken, DPM, RN, Oscar Alvarez, PhD, Lee Markowitz, DPM, Christopher Comfort, MD, and Linda Waltrous, RN

   During the last few years, improvements continue to abound in wound care treatments and therapeutics. Specialized dressings, circulation boots, monochromatic infrared therapy, skin substitutes and negative pressure therapy along with variety of vehicles to deliver silver are only a few of the advances. There have also been emerging developments in the diagnostic arena, including thermography, infrared temperature devices, pressure detection mats and devices to test for sensory defects and neuropathy.    Despite all of these advances, standard wound care (sharp debridement, offloading, moist dressing and compression) still provides a great starting place for treatment of both acute and chronic wounds. In a study on the healing rate of 203 diabetic foot ulcers, Sheehan, et. al., discovered that the percent change in wound area from baseline at four weeks is a robust predictor of healing diabetic foot ulcers at 12 weeks. They concluded that in 30 days if an ulcer had an area reduction of less than 53 percent (using standard care), then the wound was not likely to heal at 12 weeks. Accordingly, at this point, one should consider an alternative or more aggressive treatment.    The ability to predict if a wound is going to close in 12 weeks using standard care should not be understated. This can have a huge impact on the wound care community at all levels including the patient and his or her family, the caregiver and facility, as well as insurance companies and Medicare.    In general, the technology of wound care has focused on treatment advances. However, little has been achieved in wound assessment. Elaborate flow charts have established treatment plans and the formulation of best practice scenarios based upon outcomes research. Fortunately, significant progress has been reported and DPMs are salvaging limbs with much greater success.

Digital Photo Planimetry: What You Should Know

   Quietly in the background, there have been a few advances in diagnostics and wound measurements. A new computer photo planimetry program (PictZar®, CDM BioVisual Technologies) has been shown to be easy to use while providing highly accurate wound measurements. Diagnostic ultrasound provides practitioners with the ability to discover occult pathology and give exact depth measurements of a wound using the Wound-Mapping™ Ultrasonic Assessment Method.    The wound mapping technique is a diagnostic procedure that offers the potential for even better results. Not only does it provide new and never before available information for the clinician, it reveals this information in real time when the patient will benefit most.    Digital photo planimetry provides image documentation and surface measurements to monitor the patient’s results with specific treatment regimens. Simple accurate data directs the clinician toward what is working best for the patient. When the services one is providing are helping to close wounds, the wound care team stays motivated and on track.    Planimetry is the mensuration of plane surfaces as opposed to sterometry or the mensuration of volumes. There are a number of necessary reasons to take photographs of wounds and measure wounds beside the aforementioned ability to predict healing. A photograph provides excellent documentation with the ability to produce a wound history by archiving serial pictures of the pathology or skin lesion.    Additionally, photographs serve as an objective monitor of the wound healing process. With the addition of accurate measurements on the photograph, this imaging can be a “yardstick” to measure the effectiveness of specific treatment regimens. Today, clinicians use wound measurements as an objective basis for reimbursement for a variety of dressings, skin replacements, negative pressure therapy and surgical debridement.

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