Wound Healing Trajectory
Measurement of healing trajectory is useful for research and validating new clinical or therapeutic approaches. A variety of healing rate methods have been used with varying degrees of success and reproducibility (Carrel and Hartmann, 1916; Du Nouy, 1916; Snowden, 1984; Hokanson et al, 1991; Tranquillo and Murray, 1993).
The measurement of healing rate has evolved from a metric based and perimeter (Gilman, 1990) to a more predictive model by Margolis et al (1993) that included the initial venous ulcer healing rates over the first 4 weeks of therapy.
With tissue remodeling, chronic wound treatments are often associated with increased wound size in the first week of treatment. Several research groups observed (Margolis et al, 1993; Tallman et al, 1997; Cherry et al, 1998) that all patients with negative initial healing rates (weeks 2 to 4) failed to heal within 24 weeks. Patients failing to positively respond to a therapy after 1 month are unlikely to respond after longer periods of time and the management should be reconsidered.
In everyday practice healing trajectories may be more cumbersome with simpler metrics also working. Kantor and Margolis (2000) have proposed using the percent change in wound area over the first 4 weeks, whereas Margolis et al (2000) have proposed using an algorithm based on wound size and duration, that is commonly known before starting therapy. Both methodologies have become routine in everyday practice. The concept of healing trajectories remains important to future wound research and management (Cardinal et al, 2008).
The usefulness of wound-healing trajectories as predictors of validated treatment efficacy for diabetic foot ulcers and venous stasis ulcers (Steed et al, 2006). These trajectories are also useful as an outcome measure for pressure injury management (Payne et al, 2001).