Effective wound measurement is pivotal to effective wound management. It is essential to be able to assess the rate of closure of a wound in order to assess the effectiveness of current treatment strategies, and adapt as appropriate. Wound photography can play a huge role in tracking progress and documenting, as long as it is done properly.
Measuring Empirical Wound Size
We have previously discussed techniques for the empirical measurement of wound size. However, it is possible to provide additional information over and above the empirical size of a wound through the use of digital images. As well as giving an assessment of wound size, a digital photograph is able to capture other important information such as extent of necrotic tissue, degree of epithelialization, condition of the periwound area, and so on. By monitoring closure of a wound over time through photography, it is possible to assess a large number of clinical factors in addition to wound size alone.
Patient Consent to Wound Photography
The introduction of cheap digital wound photography and ease of downloading photographs to patient records or other files means that this procedure is becoming more common in everyday clinical practice. It is also increasingly being used as a means to prevent litigation. However, it should be remembered that patient consent may be required before a wound is photographed and the image stored if this is not part of the facility’s admission policy.1
Accuracy of Digital Wound Photography
The downside of the ready availability of digital wound photography is that pictures of varying quality can be captured, which may undermine the benefit of the technology. The American Professional Wound Care Association has issued some guidelines for the use of photography in wound management, in which the importance of a standardized approach to documenting wound healing through digital photography is emphasized.2 The 10 key guidelines for the use of digital images in documenting wound healing are listed in the box below. In order to improve accuracy and consistency of this technology, digital photography can also be coupled with computerized planimetry to adjust for parallax and other distortions.
Videos & Wound Care
As an extension to wound photography in wound management, some facilities are also using video images of wounds as a way both to document wound progress as well as to share information via videoconference.1
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APWCA Practical Guidelines for digital images documenting wound care/healing over time2
- Use the same digital camera for successive images.
- Use the same image resolution settings on the digital camera (several are available).
- Use the same light source, intensity and angle.
- Have the camera at the same angle, distance, rotation and height from the wound.
- Choose either pre or post debridement for all images in a sequence.
- Select the same magnification for the digital camera lens (“zoom”)
- Choose a naming convention and put case identification, number or date in the image.
- Choose image archive software that will allow key word searches and audio tags with images.
- Have the wound in the same relative position as previous images.
- Use “fiducial” reference markers wherever possible to achieve consistency (i.e. patient code, date, scale).
- Sussman C and Bates-Jensen B. Wound Care. A collaborative practice manual for health professionals. 3rd Ed. Wolters Kluwer/Lippincott Williams & Wilkins, Philidelphia, US. 2007.
- American Professional Wound Care Association. Proposed APWCA photographic guidelines for wounds. Available from http://www.apwca.org/guidelines/photographic.cfm