What Measurement Of Wound Healing Is Most Valuable?

Great, provocative work recently in the International Wound Journal by our colleagues Professor Keith Harding and coworkers.¹ In their study, they note that healing in total can be a challenging metric to measure, as every wound is very different. In the research world, this translates into difficulty in matching study cohorts, especially when there are not very large subject pools available. Also, they note that the lengthy time necessary to heal many wounds requires that the associated study also takes substantial time. This makes high-quality RCTs with statistically significant and applicable data few and far between.

Taking a slightly different viewpoint on evaluating outcomes in wound healing, the authors looked at venous leg ulcers and found they exhibited a linear healing trajectory over a four-week period. Researchers collected data on gross area healed, percentage area healed, and advance of the wound margin. The linear nature of these pathways provides a more clear-cut benchmark by which to measure if a given intervention is accelerating healing or in fact, slowing it down. The authors found wound margin advancement to be the most linear, independent of initial ulcer size.¹

I think we can sum all of this up by acknowledging that we still need to do a lot better job of measuring what we manage. I don’t think we collectively do that very well yet in the USA. Our current electronic medical records are not primarily designed for tracking outcomes. Rather (outside of the Department of Veterans Affairs’ EMR), they are designed for billing.

Despite these obstacles, I think we should continue to resolve to do a better job and these sorts of tricks might help us help our patients.

Dr. Armstrong is Professor of Surgery at the Keck School of Medicine at the University of Southern California. He is the Director of the Southwestern Academic Limb Salvage Alliance (SALSA). 

Editor’s note: This blog originally appeared at: https://diabeticfootonline.com/2021/08/13/measuring-progress-to-healing-a-challenge-and-an-opportunity-the-value-of-wound-margin-advancement/. It is adapted with permission from the author.

Reference

1. Bull RH, Staines KL, Collarte AJ, Bain DS, Ivins NM, Harding KG. Measuring progress to healing: a challenge and an opportunity. Int Wound J. 2021. Online ahead of print. Available at: doi: 10.1111/iwj.13669 . Accessed August 19, 2021.