5/9/2017 ClinicalassessmentofwoundsUpToDate

Authors: DavidGArmstrong,DPM,MD,PhD,AndrewJMeyr,DPM
SectionEditors: HilarySanfey,MD,JohnFEidt,MD,JosephLMills,Sr,MD,RussellSBerman,MD
DeputyEditor: KathrynACollins,MD,PhD,FACS

ContributorDisclosures

Alltopicsareupdatedasnewevidencebecomesavailableandourpeerreviewprocessiscomplete.
Literaturereviewcurrentthrough:Apr2017.|Thistopiclastupdated:Feb18,2016.

INTRODUCTIONAwoundrepresentsadisruptionofthenormalstructureandfunctionoftheskinandsoft
tissuestructureandmaybeduetoavarietyofmechanismsandetiologies[1].Theclinicalassessmentof
woundsbeginswithadeterminationofwhetherthewoundisacuteorchronicinnature.Acutewoundsare
thoseinwhichhealingisanticipatedtoprogressthroughanorderlyphysiologicsequenceofinflammation,
proliferationandmaturation[2,3].Achronicwoundmaybedefinedasonethatisphysiologicallyimpaired
becauseofinadequateangiogenesis,impairedinnervation,orimpairedcellularmigrationamongother
reasons[4].Examplesofchronicwoundsincludeischemiculcers,venousulcers,diabeticfootulcersand
infectedwoundsincludingsurgicalsiteinfections[5,6].

Theclinicalassessmentofacuteandchronicwounds,includingdifferentiatingthemostcommonchronic
ulcers,willbereviewed.Treatmentofchronicwoundsisdiscussedseparately.

(See"Basicprinciplesofwoundmanagement".)

(See"Overviewoftreatmentofchronicwounds".)

(See"Managementofdiabeticfootulcers".)

(See"Medicalmanagementoflowerextremitychronicvenousdisease",sectionon'Ulcercare'.)

(See"Clinicalstagingandmanagementofpressureinducedskinandsofttissueinjury".)

(See"Treatmentofchroniclowerextremitycriticallimbischemia".)

CLINICALASSESSMENTAnypatientwithawoundorulcerationshouldundergoacompletehistoryand
physicalexamination,includingreviewofsystems.Thehistoryshouldincludetheelementsbelow,andseek
toidentifyriskfactorsassociatedwithnonhealing.

CurrentwoundhistoryAskthepatientabouttheonsetandperceivedcausalfactorsforthecurrent
wound.Havetherebeenanyqualitativechanges(size,drainage)tothewoundovertime?Whatisthe
currentwoundcareregimen?Haveanyothertreatmentsbeentried?Isthewoundpainful?Howsevere
isthepain?Itisimportanttorealizethatpatientswithneuropathycanhavepain,whichmayindicate
involvementofdeeperstructures.

PriorwoundhistoryAskthepatientaboutthepresenceofpriorwoundsorulcers.Whatweretheir
locationsandwhat,ifany,previousmeasureswereusedtoeffectwoundhealing?

MedicalhistoryDetermineifthepatienthasanymedicalconditionsthatareriskfactorsfornonhealing
suchasdiabetes,peripheralarterydisease,andchronickidneydisease.

SocialhistoryDoesthepatienthaveahistoryofsmoking?Isthereasupportivesocialenvironmentfor
woundmanagement?Canthepatientadequatelynavigatehisorherenvironmentwithorwithout
assistanceofpeopleordevices?Isthepatientemployed?Howwillwoundcareaffecttheirdailylife?
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