Wound Assessment and Patient Evaluation
Start with the patient, not the hole
Wound assessment begins with the host: comorbidities (diabetes, peripheral artery disease, venous insufficiency, immunosuppression, obesity, malnutrition), medications (corticosteroids, anticoagulants, chemotherapy), pain, and nutritional status (unintentional weight loss, low albumin/prealbumin, inadequate protein and calorie intake). Use a validated risk tool - Braden for pressure injury - and assess perfusion before planning compression. An ankle-brachial index (ABI) above 0.9 generally supports full compression; 0.5–0.8 signals modified therapy; below 0.5, or a non-compressible artery, warrants vascular referral and no compression.
Describe the wound in reproducible terms
Document location, length × width × depth using the same method each time (ruler, tracing, or photography with a scale marker), tissue types as percentages (granulation, slough, eschar), exudate amount and character, periwound skin, wound edges, and undermining or tunneling described by clock face plus depth. Note odor after cleansing and pain on a consistent scale. Differentiate colonization from infection: erythema, warmth, induration, purulence, increasing pain, and stalled healing suggest infection or biofilm.
Name the wound correctly
Staging belongs to pressure injuries only (NPIAP stages 1–4, unstageable, deep tissue pressure injury). Never apply pressure-injury staging to venous, arterial, or diabetic foot ulcers - a very common distractor. Use etiology-specific classification for diabetic foot ulcers (Wagner, University of Texas) and describe venous disease by CEAP where appropriate.
Trap and rule of thumb
A question showing a stable, dry, necrotic heel in a patient with severe PAD usually tests whether you will debride without assessing perfusion - don't. Rule of thumb: no compression and no sharp debridement of ischemic tissue until perfusion is documented.