Introduction to assessing patients with an ulcer or wound

Assess the wound and the limb or local area, within the clinical context of the patient. This is essential to complete the first step in wound management—establishing the aetiology of the wound. Wound management is tailored to the mechanism of injury and cannot be undertaken without an accurate diagnosis.

Using the HEIDI acronym for holistic care, assessment and management consists of history, examination, investigation, diagnosis and implementation of care; see A framework for ulcer and wound management. Regular review and reassessment of the patient and the wound is essential.

Table 1. A framework for ulcer and wound management
Activity	Description
History	Undertake a thorough medical and medication history, including smoking status and alcohol intake. Determine precipitating factors for the ulcer, and its progress. Determine the impact (eg physical, social, financial, psychological) of the ulcer on the patient.
Examination	Examine the patient, then the ulcer, local area and surrounding skin and tissues (use TIME framework; see Wound characteristics summarised using the TIME acronym). Document examination findings and take photographs of the wound.
Investigations	Investigations may include blood tests, wound swabs, punch or elliptical biopsy, imaging, and vascular assessment.
Diagnosis	Establish an accurate aetiology and manage the underlying pathophysiology; consider specialist referral. Consider differential diagnoses, including rare and uncommon causes. Discuss the expected prognosis and possible complications with the patient, especially if the ulcer is not expected to heal.
Implementation of care	Interventions are specific to the aetiology of the ulcer; consider interventions to: correct pathophysiology manage symptoms address lifestyle and behavioural issues manage factors that impair wound healing (eg inadequate nutrition). Ensure patients understand their diagnosis and prognosis, and create a plan for review and evaluation. Provide patient information sheets and encourage a collaborative relationship between the patient, healthcare team and carers. Document the wound management plan and the information provided.