Surgical Pathology to Describe the Clinical Margin of Debridement of Chronic Wounds Using a Wound Electronic Medical Record

• Published in: Journal of the American College of Surgeons Vol. 209; no. 2; pp. 254 - 260.e1
• Main Authors: Golinko, Michael S., MD, Joffe, Renata, MD, de Vinck, David, DO, Chandrasekaran, Eashwar, MS, Stojadinovic, Olivera, MD, Barrientos, Stephan, MS, Vukelic, Sasa, MD, Tomic-Canic, Marjana, PhD, Brem, Harold, MD, FACS
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-08-2009; Elsevier
• Subjects: Biological and medical sciences; Chronic Disease; Debridement - methods; General aspects; Humans; Medical Records Systems, Computerized; Medical sciences; Miscellaneous; Outcome and Process Assessment (Health Care); Public health. Hygiene; Public health. Hygiene-occupational medicine; Quality Assurance, Health Care; Surgery; Wounds and Injuries - pathology; Wounds and Injuries - surgery; DFU; PU; diabetic foot ulcer; venous ulcer; WEMR; Wound Electronic Medical Record; pressure ulcer; VU; Medicine; Anatomic pathology; Chronic; Treatment; Surgery; Debridment; Wound; Electronic medical record
• ISSN: 1072-7515; 1879-1190
• DOI: 10.1016/j.jamcollsurg.2009.04.012

Background Chronic wounds, including diabetic foot ulcers (DFU), pressure ulcers (PU), and venous ulcers (VU) result from multiple physiologic impairments. Operative debridement is a mainstay of treatment to remove nonviable tissue and to stimulate wound healing. Unlike tumor resection, however, operative wound specimens are not routinely sent for pathology. The objective of this study was to describe the pathology present in chronic wounds. Study Design Pathology reports of the skin edge and wound base from 397 initial debridements in 336 consecutive patients with chronic wounds were retrospectively reviewed. All data were entered and stored in a Wound Electronic Medical Record. Pathology data were extracted from the Wound Electronic Medical Record, coded, and quantified. Results Up to 15 distinct histopathologic findings across 7 tissue types were observed after review of pathology reports from chronic wounds. Specifically, the pathology of epidermis revealed hyperkeratosis: 66% in DFUs, 31% in PUs, and 29% in VUs. Dermal pathology revealed fibrosis in 49% of DFUs, 30% of PUs, and 15% of VUs. Wound bed pathology revealed necrosis in the subcutaneous tissue in 67% of DFUs, 55% of PUs, and 19% of VUs. Fibrosis was reported in between 19% and 52% of all wound types. Acute osteomyelitis was present in 39% of DFUs, 33% of PUs, and 29% of VUs. Conclusions This observational study of the histopathology of initial surgical debridement of chronic wounds revealed a wide range of findings across multiple tissue levels. Although certain findings such as osteomyelitis and gangrene have been shown to directly relate to impaired wound healing and amputation, other findings require additional investigation. To rigorously define a margin of debridement, a prospective study relating histopathology and clinical outcomes such as healing rates and amputation is needed.