References

Wendelken ME, Berg WT, Lichtenstein P Wounds measured from digital photographs using photodigital planimetry software: validation and rater reliability. Wounds. 2011; 23:(9)267-275

Romanelli M, Gaggio G, Piaggesi A Technological advances in wound bed measurements. Wounds. 2002; 14:(2)58-66

Gethin G. The importance of continuous wound measuring. Wounds UK. 2006; 2:(2)60-68

Se CK, Gordillo GM, Roy S Human skin wounds: a major and snowballing threat to public health and the economy. Wound Repair Regen. 2009; 17:(6)763-771 https://doi.org/10.1111/j.1524-475X.2009.00543.x

Health Service Executive. National Service Plan 2014. 2013. https://tinyurl.com/ybac8xuo (accessed 6 June 2017)

Kimberlin CL, Winterstein AG. Validity and reliability of measurement instruments used in research. Am J Health Syst Pharm. 2008; 65:(23)2276-2284 https://doi.org/10.2146/ajhp070364

Principles of best practice: diagnostics and wounds. A consensus document.: MEP Ltd; 2008

Kruse CR, Nuutila K, Lee CC The external microenvironment of healing skin wounds. Wound Repair Regen. 2015; 23:(4)456-464 https://doi.org/10.1111/wrr.12303

Gerrish K, Lathlean J. The research process in nursing, 7th edn. : John Wiley & Sons; 2015

Liberati A, Altman DG, Tetzlaff J The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009; 339 https://doi.org/10.1136/bmj.b2700

Cochrane handbook for systematic reviews of interventions Version 5.1.0. 2011. http://handbook.cochrane.org/ (accessed 6 June 2017)

Glynn L. A critical appraisal tool for library and information research. Library Hi Tech. 2006; 24:(3)387-99

Shukl VK, Shukla D, Tiwary SK Evaluation of pH measurement as a method of wound assessment. J Wound Care. 2007; 16:(7)291-294 https://doi.org/10.12968/jowc.2007.16.7.27062

Gethin GT, Cowman S, Conroy RM. The impact of Manuka honey dressings on the surface pH of chronic wounds. Int Wound J. 2008; 5:(2)185-194 https://doi.org/10.1111/j.1742-481X.2007.00424.x

Ono S, Imai R, Ida Y Increased wound pH as an indicator of local wound infection in second degree burns. Burns. 2015; 41:(4)820-824 https://doi.org/10.1016/j.burns.2014.10.023

Hoffman R, Noble J, Eagle M. The use of proteases as prognostic markers for the healing of venous leg ulcers. J Wound Care. 1999; 8:(6)273-276 https://doi.org/10.12968/jowc.1999.8.6.25885

James TJ, Hughes MA, Cherry GW, Taylor RP. Simple biochemical markers to assess chronic wounds. Wound Repair Regen. 2000; 8:(4)264-269

Tarlton JF, Vickery CJ, Leaper DJ, Bailey AJ. Postsurgical wound progression monitored by temporal changes in the expression of matrix metalloproteinase-9. Br J Dermatol. 1997; 137:(4)506-516

Tarlton JF, Bailey AJ, Crawford E Prognostic value of markers of collagen remodeling in venous ulcers. Wound Repair Regen. 1999; 7:(5)347-355

Trengove NJ, Langton SR, Stacey MC. Biochemical analysis of wound fluid from nonhealing and healing chronic leg ulcers. Wound Repair Regen. 1996; 4:(2)234-239 https://doi.org/10.1046/j.1524-475X.1996.40211.x

Trengove MK, Stacey MC, McCauley S Analysis of the acute and chronic wound environments: the role of proteases and their inhibitors. Wound Repair Regen. 1999; 7:(6)442-452

Bernatchez SF, Menon V, Stoffel J Nitric oxide levels in wound fluid may reflect the healing trajectory. Wound Repair Regen. 2013; 21:(3)410-417 https://doi.org/10.1111/wrr.12048

Edsberg LE, Wyffels JT, Brogan MS, Fries KM. Analysis of the proteomic profile of chronic pressure ulcers. Wound Repair Regen. 2012; 20:(3)378-401

Ladwig GP, Robson MC, Liu R Ratios of activated matrix metalloproteinase-9 to tissue inhibitor of matrix metalloproteinase-1 in wound fluids are inversely correlated with healing of pressure ulcers. Wound Repair Regen. 2002; 10:(1)26-37

Wyffels JT, Fries KM, Randall JS Analysis of pressure ulcer wound fluid using two-dimensional electrophoresis. Int Wound J. 2010; 7:(4)236-248 https://doi.org/10.1111/j.1742-481X.2010.00672.x

Muller M, Trocme C, Lardy B Matrix metalloproteinases and diabetic foot ulcers: the ratio of MMP-1 to TIMP-1 is a predictor of wound healing. Diabet Med. 2008; 25:(4)419-426 https://doi.org/10.1111/j.1464-5491.2008.02414.x

Liu Y, Min D, Bolton T Increased matrix metalloproteinase-9 predicts poor wound healing in diabetic foot ulcers. Diabetes Care. 2009; 32:(1)117-119 https://doi.org/10.2337/dc08-0763

Robicsek F, Masters TN, Daugherty HK. The value of thermography in the early diagnosis of postoperative sternal wound infections. Thorac Cardiovasc Surg. 1984; 32:(4)260-265 https://doi.org/10.1055/s-2007-1023400

Horzic M, Bunoza D, Maric K. Contact thermography in a study of primary healing of surgical wounds. Ostomy Wound Manage. 1996; 42:(1)36-44

Horzic M, Bunoza D, Maric K. Three-dimensional observation of wound temperature in primary healing. Ostomy Wound Manage. 1996; 42:(8)38-47

Armstrong DG, Lavery LA. Monitoring neuropathic ulcer healing with infrared dermal thermometry. J Foot Ankle Surg. 1996; 35:(4)335-338

Nakagami G, Sanada H, Iizaka S Predicting delayed pressure ulcer healing using thermography: a prospective cohort study. J Wound Care. 2010; 19:(11)465-472 https://doi.org/10.12968/jowc.2010.19.11.79695

Armstrong DG, Lipsky BA, Polis AB, Abramson MA. Does dermal thermometry predict clinical outcome in diabetic foot infection? Analysis of data from the SIDESTEP. Int Wound J. 2006; 3:(4)302-307 https://doi.org/10.1111/j.1742481X.2006.00269.x

Mufti A, Coutts P, Sibbald RG. Validation of commercially available infrared thermometers for measuring skin surface temperature associated with deep and surrounding wound infection. Adv Skin Wound Care. 2015; 28:(1)11-16 https://doi.org/10.1097/01.ASW.0000459039.81701.b2

Dini V, Salvo P, Janowska A Correlation between wound temperature obtained with an infrared camera and clinical wound bed score in venous leg ulcers. Wounds. 2015; 27:(10)274-278

Siah CJR, Childs C. Thermographic mapping of the abdomen in healthy subjects and patients after enterostoma. J Wound Care. 2015; 24:(3)112-120 https://doi.org/10.12968/jowc.2015.24.3.112

Gethin G. The significance of surface pH in chronic wounds. Wounds UK. 2007; 3:(3)52-55

Percival SL, McCarty S, Hunt JA, Woods EJ. The effects of pH on wound healing, biofilms, and antimicrobial efficacy. Wound Repair Regen. 2014; 22:(2)174-186 https://doi.org/10.1111/wrr.12125

Percival SL, Finnegan S, Donelli G Antiseptics for treating infected wounds: Efficacy on biofilms and effect of pH. Crit Rev Microbiol. 2016; 42:(2)293-309 https://doi.org/10.3109/1040841X.2014.940495

Jones EM, Cochrane CA, Percival SL. The effect of pH on the extracellular matrix and biofilms. Adv Wound Care (New Rochelle). 2015; 4:(7)431-439 https://doi.org/10.1089/wound.2014.0538

Nagoba BS, Suryawanshi NM, Wadher B, Selkar S. Acidic environment and wound healing: a review. Wounds. 2015; 27:(1)5-11

Schneider LA, Korber A, Grabbe S, Dissemond J. Influence of pH on woundhealing: a new perspective for wound-therapy?. Arch Dermatol Res. 2007; 298:(9)413-420 https://doi.org/10.1007/s00403-006-0713-x

Liu Y, Kalen A, Risto O, Wahlstrom O. Fibroblast proliferation due to exposure to a platelet concentrate in vitro is pH dependent. Wound Repair Regen. 2002; 10:(5)336-340

Nagoba BS, Gandhi RC, Wadher BJ Microbiological, histopathological and clinical changes in chronic infected wounds after citric acid treatment. J Med Microbiol. 2008; 57:(Pt 5)681-682 https://doi.org/10.1099/jmm.0.47647-0

Leveen HH, Falk G, Borek B Chemical acidification of wounds. An adjuvant to healing and the unfavorable action of alkalinity and ammonia. Ann Surg. 1973; 178:(6)745-753

Lambers H, Piessens S, Bloem A Natural skin surface pH is on average below 5, which is beneficial for its resident flora. Int J Cosmet Sci. 2006; 28:(5)359-370 https://doi.org/10.1111/j.1467-2494.2006.00344.x

Schmid-Wendtner MH, Korting HC. The pH of the skin surface and its impact on the barrier function. Skin Pharmacol Physiol. 2006; 19:(6)296-302 https://doi.org/10.1159/000094670

Zlotogorski A. Distribution of skin surface pH on the forehead and cheek of adults. Arch Dermatol Res. 1987; 279:(6)398-401

Thomas S. Wound management and dressings.: The Pharmaceutical Press; 1990

Schreml S, Szeimies RM, Karrer S The impact of the pH value on skin integrity and cutaneous wound healing. J Eur Acad Dermatol Venereol. 2010; 24:(4)373-378 https://doi.org/10.1111/j.1468-3083.2009.03413.x

pH Measurement Guide. 2014. https://tinyurl.com/y85qvsja (accessed 7 June 2017)

Booth G, McDuell B, Sears J. World of science 1.: Oxford University Press; 1999

Chapman C, Musker R, Nicholson D, Sheehan M. Eureka! Success in Science.: Heinemann Education Publishers; 2001

Mettler-Toledo. pH Theory Guide. 2007. https://tinyurl.com/y9qsc7ve (accessed 7 June 2017)

Bryant R, Nix D. Acute and chronic wounds: current management concepts, 5th edn. : Elsevier Health Sciences; 2016

Ziegler TR, Pierce GF, Herndon DN. Growth factors and wound healing: basic science and potential clinical applications.: Springer; 1997

Harding K, Armstrong DG, Barrett S The role of proteases in wound diagnostics: international consensus.: Wounds International; 2011

MMPs Made Easy. 2009. https://tinyurl.com/llnb99o (accessed 7 June 2017)

Hawkins KE, DeMars KM, Yang C Fluorometric immunocapture assay for the specific measurement of matrix metalloproteinase-9 activity in biological samples: application to brain and plasma from rats with ischemic stroke. Mol Brain. 2013; 6 https://doi.org/10.1186/17566606-6-14

Moor AN, Vachon DJ, Gould LJ. Proteolytic activity in wound fluids and tissues derived from chronic venous leg ulcers. Wound Repair Regen. 2009; 17:(6)832-839 https://doi.org/10.1111/j.1524-475X.2009.00547.x

Wound Infection Made Easy. 2014. https://tinyurl.com/y853oxtq (accessed 7 June 2017)

Lobmann R, Zemlin C, Motzkau M Expression of matrix metalloproteinases and growth factors in diabetic foot wounds treated with a protease absorbent dressing. J Diabetes Complications. 2006; 20:(5)329-335 https://doi.org/10.1016/j.jdiacomp.2005.08.007

Bullen EC, Longaker MT, Updike DL Tissue inhibitor of metalloproteinases-1 is decreased and activated gelatinases are increased in chronic wounds. J Invest Dermatol. 1995; 104:(2)236-240

Yang C, Zhu P, Yan L Dynamic changes in matrix metalloproteinase 9 and tissue inhibitor of metalloproteinase 1 levels during wound healing in diabetic rats. J Am Podiatr Med Assoc. 2009; 99:(6)489-496

Petricevich VL. Cytokine and nitric oxide production following severe envenomation. Curr Drug Targets Inflamm Allergy. 2004; 3:(3)325-332

Szentkuti A, Skala Kavanagh H, Grazio S. Infrared thermography and image analysis for biomedical use. Periodicum Biologorum. 2011; 113:(4)385-392

Zhu WP, Xin XR. Study on the distribution pattern of skin temperature in normal Chinese and detection of the depth of early burn wound by infrared thermography. Ann N Y Acad Sci. 1999; 888:300-313

Armstrong DG, Lavery LA. Monitoring healing of acute Charcot's arthropathy with infrared dermal thermometry. J Rehabil Res Dev. 1997; 34:(3)317-321

van Netten JJ, Prijs M, van Baal JG Diagnostic values for skin temperature assessment to detect diabetesrelated foot complications. Diabetes Technol Ther. 2014; 16:(11)714-721 https://doi.org/10.1089/dia.2014.0052

Andersen ES, Karlsmark T. Evaluation of four non-invasive methods for examination and characterization of pressure ulcers. Skin Res Technol. 2008; 14:(3)270-276 https://doi.org/10.1111/j.16000846.2008.00290.x

Fierheller M, Sibbald RG. A clinical investigation into the relationship between increased periwound skin temperature and local wound infection in patients with chronic leg ulcers. Adv Skin Wound Care. 2010; 23:(8)369-379 https://doi.org/10.1097/01.ASW.0000383197.28192.98

Romano CL, Romano D, Dell'Oro F Healing of surgical site after total hip and knee replacements show similar telethermographic patterns. J Orthop Traumatol. 2011; 12:(2)81-86 https://doi.org/10.1007/s10195-0110135-1

Esclamado RM, Damiano GA, Cummings CW. Effect of local hypothermia on early wound repair. Arch Otolaryngol Head Neck Surg. 1990; 116:(7)803-808

Xia Z, Sato A, Hughes MA, Cherry GW. Stimulation of fibroblast growth in vitro by intermittent radiant warming. Wound Repair Regen. 2000; 8:(2)138-144

Hazenberg CEVB, Van Netten JJ, Van Baal SG, Bus SA. Assessment of signs of foot infection in diabetes patients using photographic foot imaging and infrared thermography. Diabetes Technol Ther. 2014; 16:(6)370-377 https://doi.org/10.1089/dia.2013.0251

Sussman C, Bates-Jensen BM. Wound care: a collaborative practice manual, 4th edn. : Lippincott Williams & Wilkins; 2012

Gottrup F, Apelqvist J, Price P Outcomes in controlled and comparative studies on non-healing wounds: recommendations to improve the quality of evidence in wound management. J Wound Care. 2010; 9:(6)237-268

Pressure ulcers
Leg ulcers
Hard-to-heal wounds
Wound infections

Measurement of ph, exudate composition and temperature in wound healing: a systematic review

02 January 2018
Review
02 January 2018
Volume 2 · Issue 1

Abstract

Objective:

To assess the potential of measurements of pH, exudate composition and temperature in wounds to predict healing outcomes, and to identify the methods that are employed to measure them.

Method:

A systematic review based on the outcomes of a search strategy of quantitative primary research published in the English language was conducted. Inclusion criteria limited studies to those involving in vivo and human participants with an existing or intentionally provoked wound, defined as ‘a break in the epithelial integrity of the skin’, and excluded in vitro and animal studies. Data synthesis and analysis was performed using structured narrative summaries of each included study arranged by concept, pH, exudate composition and temperature. The Evidence Based Literature (EBL) Critical Appraisal Checklist was implemented to appraise the quality of the included studies.

Results:

A total of 23 studies, three for pH (mean quality score 54.48%), 12 for exudate composition (mean quality score 46.54%) and eight for temperature (mean quality score 36.66%), were assessed as eligible for inclusion in this review. Findings suggest that reduced pH levels in wounds, from alkaline towards acidic, are associated with improvements in wound condition. Metalloproteinase-9 (MMP-9), matrix metalloproteinase-2 (MMP-2), tissue inhibitor of metalloproteinase (TIMP), neutrophil elastase (NE) and albumin, in descending order, were the most frequently measured analytes in wounds. MMP-9 emerged as the analyte which offers the most potential as a biomarker of wound healing, with elevated levels observed in acute or non-healing wounds and decreasing levels in wounds progressing in healing. Combined measures of different exudate components, such as MMP/TIMP ratios, also appeared to offer substantial potential to indicate wound healing. Finally, temperature measurements are highest in non-healing, worsening or acute wounds and decrease as wounds progress towards healing. Methods used to measure pH, exudate composition and temperature varied greatly and, despite noting some similarities, the studies often yielded significantly contrasting results. Furthermore, a limitation to the generalisability of the findings was the overall quality scores of the research studies, which appeared suboptimal.

Conclusion:

Despite some promising findings, there was insufficient evidence to confidently recommend the use of any of these measures as predictors of wound healing. pH measurement appeared as the most practical method for use in clinical practice to indicate wound healing outcomes. Further research is required to increase the strength of evidence and develop a greater understanding of wound healing dynamics.

Wound measurement can assist in determining treatment plans1 and in comparing and analysing treatment outcomes,2 while continuous wound measurement can signal wound healing ability3 and thus facilitate earlier provision of more appropriate interventions in wounds that require more aggressive treatments, referral to specialist services or those that require a palliative approach.1 Predicting wound healing is especially important in the present healthcare environment in which cost containment has become a major concern.4,5 In general, measurement can be described as the allocation of numerical values to observations with the aim of quantifying phenomena.6 In healthcare, as many of these are abstract concepts, for example, quality of life and patient concordance, measurement requires the operationalisation of defined variables, as well as the development and application of instruments to quantify these variables.6 For example, the efficacy of wound treatment could be operationalised as the rate of wound healing, and the implemented measurement method could record the changes in wound size during a study period. Measurement of outcomes is of key interest in healthcare research where changes are the result of interventions. In addition to assessing the quality of the research supporting this data, evaluating the reliability and validity of measurement methods is of central importance to ensure the accuracy of the findings.6

Register now to continue reading

Thank you for visiting Wound Central and reading some of our peer-reviewed resources for wound care professionals. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Access to clinical or professional articles

  • New content and clinical updates each month

Register
Or continue by

Signing in with your registered email address

wound healing
exudate
temperature
pH
matrix