Essential Elements of Wound Evaluation
In previous blog postings on Chronic Wounds, we covered many of the different elements of malignancy development in chronic wounds. We covered the incidence of malignancy in chronic wounds, which is much higher than is probably generally recognized. We also discussed the difference between primary malignancies which have ulcerated and true secondary malignancies which develop because of the chronic wound. We also discussed some of the specific features of malignancy development in chronic wounds.
In each posting the importance of comprehensive evaluation was stressed to ensure the greatest level of confidence in your diagnosis. Pathologic evaluation of wound biopsies by a laboratory and pathologists who have a greater level of experience and interest in chronic wounds is essential to avoid getting generic diagnoses with limited clinical utility from your biopsies.
Let’s spend a few minutes on the various aspects of comprehensive wound analysis, working backward. It’s important that each of these elements be done properly and optimized to ensure the maximal return is obtained from each biopsy. It’s like a row of dominos. If one is out of place, the entire series of steps can be put in jeopardy.
The Report
It’s important for your pathology report to comprehensively report the findings that are identified in the workup performed in the laboratory and the evaluation by the pathologist. 4path utilizes synoptic reporting as much as possible in our wound reports. Synoptic reporting provides the physician with a comprehensive listing of the pertinent pathologic findings from the biopsy, including those features which are seen, as well as those which are not (as is relevant and possible). Each is clearly listed with the results of analysis/evaluation.
The Examination
It’s important to understand that a wound biopsy is not just a mere routine procedure. While most laboratories look at wound biopsies in this “routine” manner, that is not the case with 4path, which looks at each case as a unique opportunity to investigate and evaluate the wound for elements that should, and should not be in the wound. Our examination can help look at the wound healing dynamics and seek to report the elements that can potentially play a role in the selection or modification of a patient’s treatment regimen for optimal response. Last, we take a comprehensive approach in the evaluation of the submitted material for the presence of malignant elements, reporting both positive and negative findings. Be sure to use a laboratory that will provide you with a comprehensive examination to ensure you obtain the most information possible from the procedure.
The Biopsy
Proper performance of the biopsy procedure is essential in the attainment of a good quality biopsy. Elsewhere in this web site, we have assembled a variety of resources, including videos, which demonstrate the performance of various types of skin biopsies. While these videos are helpful to you, the clinician, they should not be considered as “training” to allow you to do biopsies. The decision to do, or not do ANY procedure is your decision alone and you are solely responsible for the proper execution of the procedure, including all outcomes. To view these videos, please click here.
In addition to the information provided on the videos, here are some additional caveats.
- When injecting anesthesia, surround the lesion rather than directly inject into the biopsy site, to help prevent distortion from the anesthetic agent.
- When selecting the area to biopsy, consider obtaining an interface between normal and abnormal if possible.
- Use sharp instruments to help reduce the trauma to the biopsy site
- Select the proper type of biopsy procedure for the specific lesion. A white paper on this topic is available from 4path or by clicking here.
- When obtaining the biopsy, be sure not to crush or squeeze the lesion and distort the tissue. A needle or skin hook (sharp) can help reduce crush artifact.
- Only perform biopsies with techniques that you are familiar and on patient sites that you are comfortable with. Don’t perform biopsies unless you are qualified.
- Place the specimen into appropriate fixative or transport media as soon as possible to avoid air-dry artifact.
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4path provides comprehensive wound biopsy evaluation, which includes detailed findings in the wound (not just a one line diagnosis…like most labs), as well as a comprehensive evaluation for the presence of primary and secondary malignancies.
Contact 4path today to provide this unique service to your patients with chronic wounds. Call 877-884-7284 (877-88-4path) or send us an e-mail to 4info@4path.com to talk with a laboratory representative about this comprehensive program.
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