Triangle of Wound Assessment Made Easy: Revisited

Abstract

Objective: We have provided evidence based critical review of the “Triangle of wound assessment
made easy”.
Background: Wound assessment is a vital step in managing patients with acute and chronic
wounds in daily clinical practice. The natural progression of most wounds is to heal naturally
in a coherent and timely manner, although a minority of wounds will fail to heal. The aim of
treating recalcitrant wounds that fail to heal is to control symptoms and delay or prevent complications.
One vital step in managing wounds is proper and comprehensive evidence based
wound assessment.
Methods: We have carried out literature review including systemic reviews, met analysis pertaining
wound assessment including international guidelines.
Results: We have found few gaps in the proposed “Triangle of wound assessment made easy”
which have been addressed accordingly. We have revised the concept of (infection) i.e. “raised
white blood cell (WBC) count as a sign of infection” and argued that in up to one-half of patients,
even with severe diabetic foot infection raised temperature, WBC count, or sedimentation
rate are absent. A second point of concern is the omission of “probing to bone sign” in the
diagnostic criteria of local signs of infection. Recent clinical studies have demonstrated that in
the presence of a clinically infected ulcer, a positive Probe-to-Bone Test (PTB) test is highly
suggestive of osteomyelitis, but a negative test does not rule out the diagnosis; conversely, in
the situation of an apparently uninfected foot wound, a positive PTB test is not specific for
osteomyelitis, but this diagnosis is unlikely if the PTB test is negative. Lastly, the authors have
suggested reducing wound bio burden/manage infection through the use of topical antimicrobial
therapy-including antiseptic agents. Topical antiseptics have inconclusive proof of efficacy
in various etiology wounds and concern remain regarding their residual cytotoxicity when in
contact with newly forming granulating tissues especially when highly concentrated rinse solutions
is the common practice in developing countries of the world.