Wound bed score and its correlation with healing of chronic wounds

Abstract

Adequate wound bed preparation is essential for healing of leg ulcers, and consists of controlling exudate and edema, decreasing the bacterial burden, promoting healthy granulation tissue, and removing necrotic tissue. Currently, there is no classification system for wound bed preparation that has predictive value. Based on past work and the authors' experience, we have now developed and tested a new classification system that scores the following parameters: healing edges (wound edge effect), presence of eschar, greatest wound depth/granulation tissue, amount of exudate amount, edema, peri-wound dermatitis, peri-wound callus and or fibrosis, and a pink/red wound bed. Each parameter receives a score from 0 (worst score) to 2 (best score), and all the parameter scores are added for a total score. Each wound can have a maximum score of 16 (the best score possible), to a minimum score of 0 (the worst score possible). We used this wound bed score (WBS) system in a study of 177 patients with venous ulcers who had been prospectively treated with and randomized to either conventional therapy (compression alone) or a living bilayered skin construct (BSC). We evaluated serial photographs at baseline to determine whether the results would be predictive of complete wound closure and could validate the WBS. We found that wounds that ultimately achieved full closure had a statistically significant higher WBS than those that did not heal (p = 0.0012). This was also true when separating wounds by treatment modality: standard therapy (p = 0.044) and treatment with a BSC (p = 0.011). When dividing the WBS in the following quartile groups: scores 4-10, 10-12, 12-13, and 13-16, the percentage of healed wounds correlated with the WBS (p = 0.0008). For all wounds, a one unit increase in total WBS resulted on average in a 22.8% increase in odds of healing (OR = 1.228). This WBS seems to have validity in predicting complete wound closure in wounds treated with either standard therapy or advanced modalities, such as BSC. If confirmed and widely adopted in this and other types of wounds, it could be a useful tool in both the clinical and research setting.

Optimizing Wound Bed Preparation With Collagenase Enzymatic Debridement

“…Debridement will have an increasingly important role in wound bed preparation as studies indicate that the efficiency and frequency of debridement may impact the rate of wound closure. [44][45][46][47][48][49][50] The choice of a debridement method must take into account such factors as the setting and skill sets of clinicians or other caregivers. If complete debridement of non-viable tissue is immediately needed, only surgical/sharp debridement can completely debride necrotic tissue in one patient encounter.…”

“…43 It has been suggested that the efficiency and frequency of debridement can potentially impact healing rates. [44][45][46][47][48][49][50] Traditionally, the term debridement has been used to address the removal of necrotic, damaged or infected tissue. 51 The intervention is repeated periodically (typically once or twice a week for chronic wounds) for as long as these tissue problems are present.…”

Larvaterapia aplicada a heridas con poca carga de tejido necrótico y caracterización enzimática de la excreción secreción y hemolinfa

“…El análisis de los datos clínicos se hizo aplicando los puntajes de valoración de la herida por medio del PUSH (Pressure Ulcer Scale for Healing) y el Wound Bed Score, antes de la larvaterapia y después de ella (10,11). Asimismo, se obtuvo el consentimiento informado, y se educó al paciente y la familia sobre la larvaterapia.…”

Pressure ulcer treatment in a long-term care setting: wound bed healing with clostridial collagenase ointment versus hydrogel dressing

“…39 Higher scores of the WBS favor wound closure in PUs. Such quantitative measurement tools can provide reliable objectivity to the clinician in guiding treatment decisions until more advanced diagnostic testing, such as biological markers that correlate with wound health, is developed and becomes available.…”

“…38 The WBS has a range of 0-16, with higher scores indicating improvement. 39 Differences in demographic and clinical characteristics at baseline were analyzed with one-way analysis of variance for continuous covariates and chi-square analysis for dichotomous variables of interest. Effects of time, treatment, and an interaction of time and treatment on continuous outcomes were assessed with linear regression analyses.…”