1. Salcido, Richard "Sal" MD

Article Content

The ability to clinically document the quality of the wound through digital photography with various wound specific software applications has improved; however, opportunities to obtain more quantitative information about the characteristics of the wound remain elusive. Hopefully, future technology will be able to link the best of all the technology for common use at the bedside and provide us with a clear and precise image.

Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.

The advancement from basic and efficient use of wound planometrics (wound tracings) to the clinical photography of wounds has not kept pace with similar technologies in current use for medical imaging of the structures of interest, especially in visualizing the depth, the volume, and the viability of the tissues and surrounding structures of pressure ulcers and other chronic wounds. Modalities such as magnetic resonance imaging and computed tomography are not cost efficient and amenable to the analyses of regional wounds. Of particular interest is the ability to image the suggested clinical phenomena of deep tissue injuries. High-resolution ultrasound sonography provides a visualization and quantitative assessment of deeper skin structures, including the epidermis, dermis, hypodermis, and muscles. It is applicable to both closed wounds, such as (suspected) deep tissue injuries, as well as open wounds. Currently, the use of diagnostic ultrasound holds some promise, although it has not achieved strength of evidence ratings nor utility for common clinical use.


Much like dermatology, the specialty of wound care is a "visual specialty," not only requiring a qualitative description of the area of interest, but ample use of photographic techniques to supplement the medical record. Given the complexities and the heterogeneities of pressure ulcers and other chronic wounds, we require much more information than the thickness of the dermis or just a photographic image.


The challenges associated with the application of technologic advances to standardize measuring techniques in wound care are daunting. Once achieved, these advances will provide qualitative and quantitative information on wound healing and will add reliability to clinical research methodology, patient care, the electronic medical record, and forensics. The efficiency of recording the healing status of chronic wounds and exchanging this information with other clinicians, researchers, policymakers, and payers will expand our universe exponentially. The old adage that "A picture is worth a thousand words" should be modified to read, "A picture of a wound is worth thousands of dollars," as wound imaging will provide us with important documentation of healing and outcome data for patients with chronic wounds beyond photography alone.



The issues of cost, ease of use, and accuracy should be addressed and resolved as new technologies emerge, evolve, and become less expensive, more user-friendly, and more reliable. Recent advances, in fact, may offer us real solutions to the difficulty in achieving accurate, objective wound measurement solutions that may allow for better documentation of wound parameters and contribute to more efficient management and progress review. Additional research will be needed to highlight the key benefits for patients and healthcare providers.


Richard "Sal" Salcido, MD

Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.

Selected References


Ahn C, Salcido RS. Advances in wound photography and assessment methods. Adv Skin Wound Care 2008;21:85-93.


Buckley KM, Adelson LK, Agazio JG. Reducing the risks of wound consultation: adding digital images to verbal reports. J Wound Ostomy Continence Nurs 2009;36:163-70.


Chetney R, Sauls E. A picture speaks louder than words[horizontal ellipsis]but a digital camcorder tells the whole story. Home Healthc Nurse 2003;21:694-5.


Langemo D, Hanson D, Anderson J, Thompson P, Hunter S. Digital wound photography: points to practice. Adv Skin Wound Care 2006;19:386-7.