Practice ABC of wound healing

Wound assessment

BMJ 2006; 332 doi: http://dx.doi.org/10.1136/bmj.332.7536.285 (Published 02 February 2006) Cite this as: BMJ 2006;332:285
  1. Joseph E Grey,
  2. Stuart Enoch, research fellow,
  3. Keith G Harding
  1. Royal College of Surgeons of England and is based at the Wound Healing Research Unit, Cardiff University

    Most wounds, of whatever aetiology, heal without difficulty. Some wounds, however, are subject to factors that impede healing, although these do not prevent healing if the wounds are managed appropriately. A minority of wounds will become chronic and non-healing. In these cases the ultimate goal is to control the symptoms and prevent complications, rather than healing the wound.


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    Wounds are not just skin deep, and accurate assessment is an essential part of treatment

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    Causes of ulceration

    It is important that the normal processes of developing a diagnostic hypothesis are followed before trying to treat the wound. A detailed clinical history should include information on the duration of ulcer, previous ulceration, history of trauma, family history of ulceration, ulcer characteristics (site, pain, odour, and exudate or discharge), limb temperature, underlying medical conditions (for example, diabetes mellitus, peripheral vascular disease, ischaemic heart disease, cerebrovascular accident, neuropathy, connective tissue diseases (such as rheumatoid arthritis), varicose veins, deep venous thrombosis), previous venous or arterial surgery, smoking, medications, and allergies to drugs and dressings. Appropriate investigations should be carried out.

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    Some complications of chronic wounds

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    Local and systemic factors that impede wound healing

    Areas of abnormal pressure distribution in the diabetic foot. Plantar ulcers are most commonly seen under the hallux, on the first and fifth metatarsal heads, and under the heel

    This is the first in a series of 12 articles

    Assessing wounds

    Size of wound

    The size of the wound should be assessed at first presentation and regularly thereafter. The outline of the wound margin should be traced on to transparent acetate sheets and the surface area estimated: in wounds that are approximately circular, multiply the longest diameter in one plane by the longest diameter in the plane at right angles; in irregularly shaped wounds, add up the number of squares contained within the margin of the outline …

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