RECORDING WOUNDS DOCUMENTING WOUNDCARE

1
RECORDING WOUNDS -DOCUMENTING WOUNDCARE

• P. Plassmann

• Medical Computing Group
• University of Glamorgan, School of Computing

2
THE NEED FOR DOCUMENTATION
To provide objective information for the
clinician in order to

• monitor the progress of a healing wound
• assess the influence of clinical interventions
• verify clinical trials
• and increasingly important

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THE NEED FOR DOCUMENTATION (cont.)
Wound assessment is the only means of determining
effectiveness of the treatment interventions v
an Risjwijk 1996"Litigation awards are becoming
increasingly common in this area of care as
pressure sores are regarded as 95 preventable
Hibbs 1987
NOT DOCUMENTED NOT DONE !
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'REAL-TIME' WOUND DOCUMENTATION
TEMPERATURE

• far IR imaging
• far IR spectroscopy

OXYGEN
COLOUR

• saturation
• tension

• inflammation
• wound status

PROTOCOL
WOUND
SIZE
STRUCTURE

• area, volume
• limb size

• fractal
• dimension

BLOOD FLOW

• ultrasound Doppler
• laser Doppler
• plethysmography

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OXYGEN MEASUREMENTS
Saturation pulse oxymeter (e.g. neonatal care,
not wound healing)
Tension
tissue oxymeter
Oxygen electrode (Clark 1956)
platinum anode
silver cathode
KCl 15-50
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'REAL-TIME' WOUND DOCUMENTATION
TEMPERATURE

• far IR imaging
• far IR spectroscopy

OXYGEN
COLOUR

• saturation
• tension

• inflammation
• wound status

WOUND
SIZE
STRUCTURE

• area, volume
• limb size

• fractal
• dimension

BLOOD FLOW

• ultrasound Doppler
• laser Doppler
• plethysmography

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WOUND COLOUR

• prediction of healing time
• (Afromowitz 1987)
• presence of inflammation (infection)
• (Boardmann 1993, Melhuish, Hoppe 1996)
• wound status
• (Arnquist, Vincent 1998)

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PREDICTION OF HEALING TIME(BURN WOUNDS)
RED
probability of healing within 30 days
IR
1.8
healing time less
than 20 days
1.6
1.4
1.2
1.0
healing time longer
0.8
than 20 days
RED
640 nm
GREEN
0.6
GREEN
550 nm
IR
IR
880 nm
0.2
0.6
0.8
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DETECTION OF INFLAMMATION
Pilot Study
50
infected
60 wounds 30 infected - 27 detected 30 not inf.
- 22 detected 49 out of 60 wounds
were classified correctly (81.6).
not infected
percentage hue
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PROTOCOL
pixel colour
10
WOUND STATUS
- granulation tissue - slough - necrotic
tissue
Red Yellow Black
WOUND IMAGES
- taken by Polaroid camera - include reference
scale (color, size) - send to CWA institute for
evaluation
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'REAL-TIME' WOUND DOCUMENTATION
TEMPERATURE

• far IR imaging
• far IR spectroscopy

OXYGEN
COLOUR

• saturation
• tension

• inflammation
• wound status

WOUND
SIZE
STRUCTURE

• area, volume
• limb size

• fractal
• dimension

BLOOD FLOW

• ultrasound Doppler
• laser Doppler
• plethysmography

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TEMPERATURE MEASUREMENTS
LIMB TEMPERATURE high - infection low - bad
blood perfusion
EMISSIVITY skin 1 wound ?
PROTOCOL
IR 8-12 um
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DIABETIC FOOT ULCER
month 5

• detection of
• problem by IR
• thermography

Images courtesy of Dr. R. Harding, St. Woolos
Hospital, Newport
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'REAL-TIME' WOUND DOCUMENTATION
TEMPERATURE

• far IR imaging
• far IR spectroscopy

OXYGEN
COLOUR

• saturation
• tension

• inflammation
• wound status

WOUND
SIZE
STRUCTURE

• area, volume
• limb size

• fractal
• dimension

BLOOD FLOW

• ultrasound Doppler
• laser Doppler
• plethysmography

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BLOOD FLOW

• Ultrasound Dopplers
• Plethysmography
• Laser Dopplers

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LASER DOPPLER IMAGING
Photo of leg ulcer Flux
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'REAL-TIME' WOUND DOCUMENTATION
TEMPERATURE

• far IR imaging
• far IR spectroscopy

OXYGEN
COLOUR

• saturation
• tension

• inflammation
• wound status

WOUND
SIZE
STRUCTURE

• area, volume
• limb size

• fractal
• dimension

BLOOD FLOW

• ultrasound Doppler
• laser Doppler
• plethysmography

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TISSUE STRUCTURE
20 MHz Ultrasound fractal signature a measure
for the complexity of a ROI
Image courtesy of M.Dyson, Guy's Hospital, London
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'REAL-TIME' WOUND DOCUMENTATION
TEMPERATURE

• far IR imaging
• far IR spectroscopy

OXYGEN
COLOUR

• saturation
• tension

• inflammation
• wound status

WOUND
SIZE
STRUCTURE

• area, volume
• limb size

• fractal
• dimension

BLOOD FLOW

• ultrasound Doppler
• laser Doppler
• plethysmography

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WOUND SIZE ESTABLISHED TECHNIQUES

• LENGTH/DEPTH
• rulers
• AREA
• transparency tracings
• photographic methods

• VOLUME
• saline method
• alginate casts
• OTHER METHODS
• stereophotogrammetry
• ultrasound
• MRI scanners
• Kundin device

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EMERGING TECHNIQUES

• AREA (2D)
• digital photography

• VOLUME (3D)
• laser scanners
• stereo vision
• structured light devices

• COMMON FEATURES
• computer based
• remote measurements
• integrated databases

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2D MEASUREMENTS

• digital camera PC
• measurement programme
• wound database

• PROBLEMS
• boundary definition
• tissue flexibility
• limb curvature

PROTOCOL
VERGE VIDEOMETER Vista Medical Ltd. (Canada)
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PRECISION OF 2D MEASUREMENT TECHNIQUES
Precision error (one standard deviation as of
wound size)
12
10
8
6
wound lt 10 cm²
4
wound 10-40 cm²
2
wound gt 40 cm²
0
rulers
tracings
digital photography
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3D MEASUREMENT METHODS
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3D MEASUREMENTS
PRINCIPLE pattern aided triangulation

• PROBLEMS (as 2D)
• boundary definition
• tissue flexibility
• limb curvature

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PRECISION OF 3D MEASUREMENT METHODS
precision range
(one standard deviation in of the volume)
min. precision
(large, shallow wounds)
40
30
20
10
max. precision
(deep, small wounds)
0
saline
3D Scanners
casts
rulers
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STEREO VISION 3dMDformerly Tricorder
Technology plc., UK

• limited portability
• dedicated wound
• measurement software
• available
• trial with Bradford Royal
• Infirmary

http//www.3dmd.com
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Laser Scanner VIVID 700 Minolta Corporation

• portable ( 9kg )
• no wound measurement
• software available

http//www.minolta3d.com
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STRUCTURED LIGHT MAVIS University of
Glamorgan, UK

• trolley portable within
• hospital
• dedicated wound
• measurement instrument

http//www.comp.glam.ac.uk/pages/research/mavis/
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STRUCTURED LIGHT MAVIS-II University of
Glamorgan, UK
NEW !
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SUMMARY

• Strictly adhere to documentation
• protocol !

PROTOCOL

• Simple instrumentation (rulers, tracings)
• in clinical use, complex instruments for
• research.
• No measurement / documentation method
• is perfect.

NOT DOCUMENTED NOT DONE !