Standardization of Wound Photography

1
Standardization of Wound Photography Using the
Wound Electronic Medical Record
Chandrasekaran E, Golinko M, Rennert R, Kaplan D,
Brem H. Department of Surgery, NYU Langone
Medical Center and NYU Schol of Medicine, 530
First Ave, New York, NY 10016
RESULTS
Figure 2. Proper Orientation of the Digital
Camera As the figure shows, changes in camera
angle cause variability in wound measurements. To
minimize errors and maintain objectivity of wound
measurements, the camera lens should be oriented
parallel to the plane of the wound.
WHAT IS THE ACCURATE MEASUREMENT OF ULCER AREA?
Figure 4. Using Wound Photography to Measure
Healing/Nonhealing Over Time. Objective wound
photography enables one to track progression of
healing ulcers (Figure 4a) and calculate healing
rates. Tracking healing rates of nonhealing
ulcers (Figure 4b) can be helpful in deciding
when a change of treatment plan is necessary.
Figure 1. Wound Photography Protocol 1. Remove
all dressings and remove as much necrotic tissue,
slough, packing material and/or debris that can
be tolerated by the patient. 2. Cleanse the
wound with saline. 3. Place the ruler flat
against the distal edge of the wound and hold the
camera parallel to the plane of the wound with an
optimal distance of 0.3 and 1 meters. 4. The
digital photograph is measured using WoundImager
2.0 and entered into the WEMR along with wound
dimensions, along with presence of cellulitis,
drainage and undermining. These guidelines were
used to capture over 14,000 photographs in the
last four years, corresponding to the treatment
of over 1,100 patients and 3,400 chronic wounds.
MATERIALS METHODS
CONCLUSION
The guidelines for wound documentation developed
at this center provide a standardized methodology
to accurately and objectively record wound area
through time.
The wound electronic medical record (WEMR)
combines digital wound photography, recent area
trends and relevant clinical information into an
easily viewed and queried database. Strict
photographic guidelines based upon individual
wound etiologies were developed to reduce the
variability of chronic wound area measurements
and to facilitate informed clinical decisions.
For more information on the WEMR, please attend
the oral presentation Development of a
Relational Databank for Chronic Wounds, on June
6, 2008
REFERENCES
1.) Samad A, Hayes S, French L, Dodds S.
Digital imaging versus conventional contact
tracing for the objective measurement of venous
leg ulcers. J Wound Care. 2002 Apr11(4)137-40.
2.) Ahn C, Salcido RS. Advances in wound
photography and assessment methods. Adv Skin
Wound Care. 2008 Feb21(2)85-93 quiz
94-5. 3.) Golinko M, Chandrasekaran E, Cox D,
Brem H. A novel relational database for
clinical outcomes in patients with diabetic foot
ulcers The Wound Electronic Medical Record
(WEMR). American College of Surgeons, Surgical
Forum 2008.
Figure 3. Ulcer Specific Troubleshooting. A.
Callus is included when calculating wound length,
width, and area. B. Necrotic tissue, eschar and
slough, which are likely to be debrided, are
still included in the area of the wound. C. All
contiguous areas of non-epithelialized tissue in
the same anatomic location are included in a
single area measurement.