EUROPEAN  TISSUE  REPAIR  SOCIETY

CONCEPTS IN CLINICAL WOUND HEALING

Introduction to the DERMA Project
by Dr Marco Romanelli

Imaging cutaneous ulcers to detect the progression of a disease is a rou-tine part of medical practice. Although imaging technology has continu-ously evolved over the years in all fields of medicine, its direct application to cutaneous disorders has increased only in recent years. In fact, only over the past decade has significant research been undertaken to further develop techniques for specifically examining the skin. Advances in both the technology of imaging and computer systems have greatly supported this process and brought it closer to the clinical area. Assessment of any wound should begin with the determination of the extent of the wound. Because the extent of a wound is a dynamic process, it requires repeated systematic assessment. The total wound extent is based on the wound dimensions and the tissue level involved. The clinical evaluation of the extent of the tissue involvement due to a skin lesion and, moreover, the way a lesion evolves over time are often assessed according to the common sense and memory of the clinician. Evaluations are in general performed on the basis of clinical experience and using very basic, low-tech equipments to make objective measurements. The determination of the extent of a wound may also be accomplished by non-invasive and invasive technologies. Non-invasive wound assessment includes the measurement of perimeter, maximum dimensions of length and width, surface area, volume, amount of undermining, and determination of tissue viability. Invasive methods may be necessary to quantify the extent of a wound. The tissue involvement in a wound must be defined from its surface to its depth and may vary depending on the organs involved. The total wound extent should be determined by means of the integration of the maximum possible amount of available data.

The use of skin imaging techniques to improve the management of wounds remains a novel area for most practitioners, since the traditional approach continues to be used for clinical inspection. The techniques used to obtain an effective wound assessment are currently based on the use of transparent acetate sheets, which are applied to the ulcer so as to measure its perimeter manually. The main goal of current research is to create a system that monitors the qualitative and quantitative evolution of wounds with an easy-to-use technological system, which is able to produce an objective evaluation of the wound status and which allows the evolution of the wound to be monitored by means of measurable attributes.

Dr Marco Romannelli