Quantification of Wound Healing

  • Laura Bolton
  • Ann-Jeanette Vasko
  • Karyn Monte


Scientific study has improved cutaneous wound healing outcomes more since 1948 than at any time in recorded history. To accomplish this, scientists and clinicians measured the outcomes of healing and its intermediary processes and carefully documented what treatments yielded the best results and what measured changes were correlated with clinical healing (e.g., Bates-Jensen, 1997). In order to measure effects of any treatment on healing, one must quantify the aspect of healing affected. This chapter summarizes reliable, valid techniques for quantifying cutaneous repair and its mediating events so that clinicians and scientists can use these same principles to further elucidate and improve wound healing outcomes based on the best available evidence


Pressure Ulcer Bleed Time Hypertrophic Scar Venous Ulcer Collagen Fleece 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Ådelson, E., and Crosby, W. H., 1957, A new method to measure bleeding time: The “immersion” method, Acta Haematol (Basel) 18:281-289CrossRefGoogle Scholar
  2. Adera, H. M., James, K., Castronuovo, J. J., Byrne, M., Deshmukh, R., Lohr, J. M., 1995, Prediction of amputation wound healing with skin perfusion pressure, J. Vasc. Surg 2l(5):823-828CrossRefGoogle Scholar
  3. Babson, S. R., and Babson, A. L., 1978, Development and evaluation of a disposable device for performing simultaneous duplicated bleeding time determinations, Am. J. Clin. Pathol 70:406-408PubMedGoogle Scholar
  4. Bates-Jensen, B. M., 1997, The pressure sore status tool a few thousand assessments later, Adv. Wound Care l0(5):65-73Google Scholar
  5. Babu, M., Bai, R. P., Suguna, L., Ramachandran, K., and Ramakrishnan, K. M., 1993, Differentiation of keloid and hypertrophic scar, Phyiol. Chem. Phys. Med. NMR 25(2):113-I2OGoogle Scholar
  6. Bernal-Hoyos, E. J., and Caen, J. P., 1975, A new and simple method of quantifying the bleeding time, BioMed Express (Paris) 23(7):258-262Google Scholar
  7. Bettinger, D., Gore, D., and Humphries, Y., 1995, Evaluation of calium alginate for skin graft donor sites, J. Burn Care Rehabil 16:59-61PubMedCrossRefGoogle Scholar
  8. Biffl, W. L., Moore, E. E., Moore, F. A., and Peterson, V. M., 1996, Interleukin-6 in the injured patient: Marker of injury of mediator of inflammation? Ann. Surg 224(5):647-664PubMedCrossRefGoogle Scholar
  9. Bolton, L. L., and van Rijswijk, L., 1991, Wound healing: Meeting clinical needs, Dermatol. Nurs 3:146-160PubMedGoogle Scholar
  10. Bolton, L., Oleniacz, W., Constantine, B., Kelliher, B. O., Jensen, D., Means, B, and Rovee, D., 1985, Repair and antibacterial effects of topical antiseptic agents in vivo, in: Models in Dermatology (H. Maibach and N. Lowe, eds.) Karger, Basel, pp. 145-158Google Scholar
  11. Bolton, L. L., Pines, E., Rovee, D. T., 1988, Wound healing and the intergumentary system, in: Experimental Surgery and Physiology: Induced Animal Models of Human Disease (M. Swindel and R. J. Adams, eds.) Williams & Wilkins, Baltimore, pp. 1-9Google Scholar
  12. Borchgrevink, C. F., and Waaler, B. A., 1958, Secondary bleeding time: A new method for the differentiation of hemorrhagic diseases, Acta Med. Scand 162:361PubMedCrossRefGoogle Scholar
  13. Bowie, E. J. W., Owen, C. A. Jr., Hansen, R. J., and Isaacson, J., 1972, Electronic method for quantification of bleed time, Am. J. Clin. Path 58:255-259PubMedGoogle Scholar
  14. Byl, N. N., McKenzie, A. L., West, J. M., Whitney, J. D., Hunt, T. K., Hopf, H. W., Scheuenstuhl, H., Robinson, A. J., and Snyder-Mackler, L., 1994, Pulsed microamperage stimulation: a controlled study of healing of surgically induced wounds in Yucatan pigs, Phys. Ther 74(3):2O1-218Google Scholar
  15. Catty, R. H. C, 1965, Healing and contraction of experimental full-thickness wounds in the human, Br. J. Surg 52:542-548PubMedCrossRefGoogle Scholar
  16. Cavani, A., Zambruno, G., Marconi, A., Manca, V., Marchetti, M., Giannetti, A., 1993, Distinctive integrin expression in the newly forming epidermis during wound healing in humans, J. Invest. Dermatol lOl(4):6OO-6O4Google Scholar
  17. Chakraborty, A., and Eghbali, M., 1989, An immunoassay for qualitative estimation of collagenase activity in mammalian tissues, Clin. Biochem 24(6):455-46lCrossRefGoogle Scholar
  18. Choiniere, M., Auger, F. A., and Latarjet, J., 1994, Visual analogue thermometer: A valid and useful instrument for measuring pain in burned patients, Burns 2O(3):229-235CrossRefGoogle Scholar
  19. Clifft, J. K., 1989, Measurement of pressure ulcer volume using dental impression materials, Phy. Ther 69(8):69O-695Google Scholar
  20. Copley, A. L., and Lalich, J. J., 1942, Bleeding time, lymph time, and clot resistance in men, J. Clin. Invest 21:145PubMedCrossRefGoogle Scholar
  21. Covington, J. S., Griffin, J. W., Mendius, R. K., Tooms, R. E., and Clifft, J. K., 1989, Measurement of pressure ulcer volume using dental impression materials: Suggestions from the field, Phys. Ther 69(8):69O-695Google Scholar
  22. De Caterina, R., Lanza, M., Manca, G., Strata, G. B., Maffei, S., and Salvatore, L., 1994, Bleeding time and blceding: An analysis of the relationship of the bleeding time test with parameters of surgical bleeding, Blood 84(10), 3363-3370PubMedGoogle Scholar
  23. de la Cuadra, J. L., Jeanneret, C., and Furlan, M., 1988, Modified in vivo platelet retention test for evaluating primary hemostasis, Acta Haemat 80:103-109PubMedCrossRefGoogle Scholar
  24. De Nicola, P., 1962, Critical evaluation of methods for the study of blood coagulation, fibrinolysis and hemostasis, Throm. Diath. Haemorrh 7(Supp l):325-333Google Scholar
  25. Duke, W. W., 1910, The relation of blood platelets to hemorrhagic diseases, JAMA 55:1185CrossRefGoogle Scholar
  26. du Nuoy, P. L., 1919, Cicatrization of wounds: X. A general equation for the law of cicatrization of surface wounds, J. Exp. Med 29:329-350CrossRefGoogle Scholar
  27. Eaglestein, W. H., 1993, Occlusive dressings, J. Dermatol. Surg. Oncol 19:716-720Google Scholar
  28. Ehrlich, H. P., and Kelley, S. F., 1992, Hypertrophic scar: An interruption in the remodeling of repair; A laser Doppler blood flow study, Plast. Reconstr. Surg 90(6):993-998PubMedCrossRefGoogle Scholar
  29. Feusner, J. H., 1980, Normal and abnormal bleeding times in neonates and young children utilizing a fully standardized template technic, Am. J. Clin. Pathol 74:73-77PubMedGoogle Scholar
  30. Fong, S. S., Hung, L. K., Cheng, J. C, 1997, The cutometer and ultrasonography in the assessment of postburn hypertrophic scar, Burns 23(Suppl l):Sl2-Sl8Google Scholar
  31. Garrel, D. R., Gaudreau, P., Zhang, L. M., Reeves, I., and Brazeau, P., 1991, Chronic administration of growth hormone-releasing factor increases wound strength and collagen maturation in granulation tissue, J. Surg. Res 5l(4):297-3O2CrossRefGoogle Scholar
  32. Ghamsari, S. M., Acorda, J. A., Taguchi, K., Abe, N., and Yamada, H., 1996, Evaluation of wound healing of the teat with and without low lever laser therapy in dairy cattle by laser Doppler flowmetry in comparison with histopathology, tensiometry and hydroxyproline analysis, Br. Vet. J l52(5):583-592CrossRefGoogle Scholar
  33. Goss, R. J., 1972, Wound healing and antler regeneration, in: Epidermal Wound Healing (H. Maibach and D. Rovee, eds.), Yearbook Medical Publishers, ChicagoGoogle Scholar
  34. Green, H. A., Bua, D., Anderson, R. R., and Nishioka, N. S., 1992, Burn depth estimation using indocyanine green fluorescence, Arch. Dermatol 43(7): 128Google Scholar
  35. Grillo, H. C., Watts, G. T., and Gross, J., 1958, Studies in wound healing: I. Contraction and the wound contents, Ann. Surg 148:145-152PubMedCrossRefGoogle Scholar
  36. Hansen, G. L., Sparrow, E. M., Kommamuri, N., and Iaizzo, P. A., 1996, Assessing wound severity with color and infrared imaging of reactive hyperemia, Wound Rep. Reg 4:386-392CrossRefGoogle Scholar
  37. Hanisch, M. E., Baum, N., Beach, P. D., Griffith, D. P., and Tyler, M., 1975, A comparative evaluation of Avitene and Gelfoam for hemostasis in experimental canine prostatic wounds, Invest. Urol l2(5):333-336Google Scholar
  38. Hinman, C. D., and Maibach, H., 1963, Effect of air exposure and occlusion on experimental human skin wounds, Nature 200:377-378PubMedCrossRefGoogle Scholar
  39. Ivy, A. C., Nelson, D., and Bucher, G., 1941, The standardization of certain factors in the cutaneous “venostasis” bleeding time technique, J. Lab. Clin. Med 26:1812Google Scholar
  40. Janzarik, H., Remy, S., Morell, S., and Pabst, W., 1986, “Haemostasis time,” a modified bleeding time test and its comparison with the Duke and IVY/template bleeding times. BLUT 52(6):345-356PubMedCrossRefGoogle Scholar
  41. Kennedy, D. F., and Cliff, W. J., 1979, A systematic study of wound contraction in mammalian skin, Pathology 11:207-222PubMedCrossRefGoogle Scholar
  42. Kirk, S. J., Hurson, M., Regan, M. C., Holt, D. R., Wasserkrug, B. A., and Barbul, A., 1993, Arginine stimulates would healing and immune function in elderly human beings, Surgery 144:155-160Google Scholar
  43. Kjolseth, D., Frank, J. M., Barker, J. H., Anderson, G. L., Rosenthal, A., Acland, R. D., Schuschke, D., Campbell, F. R., Tobin, G. R., and Weiner, L. J., 1994, Comparison of the effects of commonly used wound agents on epithelialization and neovascularization, J. Am. Coll. Surg l79(3):3O5-3l2Google Scholar
  44. Ljungberg, B., and Johnsson, H., 1988, In vivo effects of low molecular weight heparin fragment on platelet aggregation and platelet dependent hemostasis in dogs, Thromb. Haemost 6O(2):232-235Google Scholar
  45. Margolis, D. J., Gross, E. A., Wood, C. R., and Lazarus, G. S., 1993, Planimetric rate of healing in venous ulcers of the leg treated with pressure bandage and hydrocolloid dressing, J. Am. Acad. Dermatol 28:418-421PubMedCrossRefGoogle Scholar
  46. Marshall, J. C., and Watson, R. W., 1997, Programmed cell death (apoptosis) and the resolution of systemic inflammation, Can. J. Surg 40(3): 169-174PubMedGoogle Scholar
  47. Matthew, I. R., Browne, R. M., Frame, J. W., and Millar, B. G., 1994, Alginate fiber dressing for oral mucosal wounds, Oral Surg. Oral Med. Oral Path 77(5):456-460PubMedCrossRefGoogle Scholar
  48. McHugh, A. A., Fowlkes, B. J., Maevsky, E. L., Smith, D. J., Jr., Rodriques, J. L., and Garner, W. L., 1997, Biomechanical alterations in normal skin and hypertrophic scar after thermal injury, J. Burn Care Rehabil 18(2): 104-108PubMedCrossRefGoogle Scholar
  49. Menger, M. D., Hammersen, F., and Messmer, K., 1992, In vivo assessment of neovascularization and incorporation of prosthetic biografts, Thorac. Cardiovasc. Surg 40(1): 19-25PubMedCrossRefGoogle Scholar
  50. Mielke, C. H., Kaneshiro, M. M., Maher, I. A., Weiner, J. M., and Rapaport, S. I., 1969, The standardized normal Ivy bleeding time and its prolongation by aspirin, Blood 34:204PubMedGoogle Scholar
  51. Mollnes, T. E., and Fosse, E., 1994, The complement system in trauma-related and ischemic tissue damage: a brief review, Shock 2(4):3Ol-3lOCrossRefGoogle Scholar
  52. Morris, O. E., Wu, L., Zhao, L. L., Bolton, L., Roth, S. I., Ladin, D. A., Mustoe, T. A., 1997, Acute and chronic animal models for excessive dermal scarring: Quantitative studies, Plast. Reconstr. Surg l00(3):674-68lGoogle Scholar
  53. Netscher, D. T., Carlyle, T., Thornby, J., Bowen, D., Harris, S., and Clamon, J., 1996, Hemostasis at skin graft donor sites: Evaluation of topical agents, Ann. Plast. Surg 36(l):7-l0PubMedCrossRefGoogle Scholar
  54. Orbach, I., Stein, D., Palgi, Y., Asherov, J., Har-Even, D., and Elizur, A., 1996, Perception of physical pain in accident and suicide attempt patients: Self-preservation vs. self-destruction, J. Psychiatr. Res 30(4):307-320PubMedCrossRefGoogle Scholar
  55. Padberg, F. T. Jr., Back, T. L., Hart, L. C., and Franco, C. D., 1992, Comparison of heated-probe laser Doppler and transcutaneous oxygen measurements for predicting outcome of ischemic wounds, J. Cardiovasc. Surg 33(6):715-722Google Scholar
  56. Paladini, R. D., Takahashi, K., Bravo, N. S., and Coulombe, P. A., 1996, Onset of re-epithelialization after skin injury correlates with a reorganization of keratin filaments in wound edge keratinocytes: Defining a potential role for keratin 16, J. Cell Biol, l32(3):38l-397Google Scholar
  57. Paul, R. G., Tarlton, J. F., Purslow, P. P., Sims, T. J., Watkins, P., Marshall, F., Ferguson, M. J., and Bailey, A. J., 1997, Biomechanical and biochemical study of a standardized wound healing model, Int. J. Biochem. Cell Biol 29(l):211-220PubMedCrossRefGoogle Scholar
  58. Phillips, T. J., Gerstein, A. D., and Lordan, V., 1996, A randomized controlled trial of hydrocolloid dressing in the treatment of hypertrophic scars and keloids, Dermatol. Surg 22:775-778PubMedCrossRefGoogle Scholar
  59. Pirone, L. A., Monte, K. A., Shannon, R. J., and Bolton, L. L., 1990, Wound healing under occlusion and non-occlusion in partial-thickness and full-thickness wounds in swine, Wounds 2(2):74-8lGoogle Scholar
  60. Rennie, J. M., and Gibson, T., 1985, Micromethod for bleeding time in the newborn, Arch. Dis. Child 60:51-53PubMedCrossRefGoogle Scholar
  61. Riet, G., Kessels, A., and Knipschild, P., 1996, A randomized clinical trial of ultrasound in the treatment of pressure, Phys. Ther 76(12):13O1-1312Google Scholar
  62. Rohrich, R. H., and Pittman, C. E., 1991, A clinical comparison of DuoDERM CGF andOp-Site donor site dressings, Wounds 3(6):221-226Google Scholar
  63. Romanelli, M., 1997, Objective measurement of venous ulcer debridement and granulation with a skin color reflectance analyzer, Wounds 9(4): 122-126Google Scholar
  64. Sawada, D. N., Fass, J. A., Katzman, R. C., Bahn, R. C, and Bowie, E. J. W., 1986, Hemostatic plug formation in normal and von Willebrand pigs: The effect of the administration of cryoprecipitate and a monoclonal antibody to Willebrand factor, Blood 67(5): 1229-1239PubMedGoogle Scholar
  65. Sawada, Y., and Yotsuyanagi, T., 1992, A technique of hemostasis of the extremities after debridement of burn wounds, Burns l8(5):4l2-4l5Google Scholar
  66. Silverstein, M. E., and Chvapil, M., 1981, Experimental and clinical experiences with collagen fleece as a hemostatic agent, J. Trauma 2l(5):388-393CrossRefGoogle Scholar
  67. Smith, P. S., Baglini, R., and Meissner, G. F., 1985, The prolonged bleeding time in Hemophilia A: Comparison of two measuring technics and clinical associations, Am. J. Clin. Pathol 83:211-215PubMedGoogle Scholar
  68. Spann, K., Mileski, W. J., Atiles, L., Purdue, G., and Hunt, J., 1996, Use of pnematonometer in burn scar assessment, J. Burn Care. Rehabil l7(6):5l5-5l7Google Scholar
  69. Suetake, T., Sasai, S., Zhen, Y. X., Ohi, T., and Tagami, H., 1996, Functional analyses of the stratum corneum in scars: Sequential studies after injury and comparison among keloids, hypertrophic scars, and atrophic scars, Arch. Dermatol l32(l2):l453-l458Google Scholar
  70. Sutor, A. H., and Bowie, E. J., 1971, Bleeding from standardized skin punctures: Automated technic for recording time, intensity and pattern of bleeding, Am. J. Clin. Pathol 55:541PubMedGoogle Scholar
  71. Thomas, A. C, and Wysocki, A. B., 1990, The healing wound: A comparison of three clinically useful methods of measurement, Decubitus 3(1): 18-25PubMedGoogle Scholar
  72. Thomas, R., Hessel, E. A., Dillard, D. H., and Haker, L. A., 1979, Standardized template bleeding time in dogs, J. Surg. Res 27:244-249PubMedCrossRefGoogle Scholar
  73. Thomson, P. D., and Smith, D. J., 1994, What is infection?, Am. J. Surg l67(lA):7S-11SCrossRefGoogle Scholar
  74. Todd, K. H., Funk, K. G., Funk, J. P., and Bonacci, R., 1996, Clinical significance of reported changes in pain severity, Ann. Emerg. Med 27(4):485-489PubMedCrossRefGoogle Scholar
  75. Toomey, K. C., Hugh, K. C., Martin, K., and Parvin, S., 1986, Clinical trial of a new disposable bleeding-time device, Am. J. Clin. Pathol 85(5):610-613Google Scholar
  76. Uchiyama, S., Bach, M. L., Didisheim, P., and Bowie, E. J. W., 1984, Clinical evaluation of a new test of hemostasis: The filter bleeding time, Thromb. Res 34:397-405PubMedCrossRefGoogle Scholar
  77. van der Does, A. J., 1989, Patients’ and nurses' ratings of pain and anxiety during burn wound care, Pain 39(l):95-lOlPubMedCrossRefGoogle Scholar
  78. van Rijswijk, L., 1996, Wound assessment and documentation, Wounds 8(2):57-69Google Scholar
  79. van Rijswijk, L., Multi-center leg ulcer study group, 1993, Full-thickness leg ulcers: Patient demographics and predictors of healing, J. Fam. Pract 36(6):625-632PubMedGoogle Scholar
  80. van Rijswijk, L., and Polansky, M., 1994, Predictors of time to healing deep pressure ulcers, Ostomy/Wound Manage 40(8):40-5lGoogle Scholar
  81. Van Winkle, W. Jr., 1967, Wound contraction, Surg. Gynecol. Obstet 125:131-142PubMedGoogle Scholar
  82. Wallace, M. S., Dyck, J. B., Rossi, S. S., and Yaksh, T. L., 1996, Computer-controlled lidocaine infusion for the evaluation of neuropathic pain after peripheral nerve injury, Pain 66(l):69-77CrossRefGoogle Scholar
  83. Willoughby, M. L. N., and Arlington, M. J., 1961, The rate of blood loss from skin punctures during the Ivy bleeding time test, J. Clin. Pathol 14:381-384PubMedCrossRefGoogle Scholar
  84. Wu, L., Siddiqui, A., Morris, D. E., Cox, D. A., Roth, S. I., and Mustoe, T. A., 1997, Transforming of growth factor β3 (TGFβ3) accelerates wound healing without alteration of scar prominence histologic and competitive reverse transcription-polymerase chain reaction studies, Arch. Surg 132:753-760PubMedCrossRefGoogle Scholar
  85. Yabon, S. A., Novick, E. S., Jain, S. S., Inhoffer, M., and Graves, D. E., 1995, Postoperative transcutaneous oxygen measurement in the prediction of delayed wound healing and prosthetic fitting among amputees during rehabilitation, Am. J. Phys. Med. Rehabil 74(3): 193-198CrossRefGoogle Scholar
  86. Young, E. K., Mann, R., Goldberg, M., Engrav. L., and Heimbach, D., 1996, Improved accuracy of burn wound assessment using laser Doppler, J. Trauma 40(6):956-96lCrossRefGoogle Scholar
  87. Yosipovitch, G., Xiong, G. L., Haus, E., Sackett-Lundeen, L., Ashkenazi, I., and Maibach, H. I., 1998, Time-dependent variations of the skin barrier function in humans: transepidermal water loss, stratum corneum hydration, skin surface pH, and skin temperature, J. Inv. Dermatol 110:20-23CrossRefGoogle Scholar
  88. Zitelli, J., 1984, Secondary intention healing: An alternative to surgical repair, Clin. Dermatol 2(3):92-l06PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2000

Authors and Affiliations

  • Laura Bolton
    • 1
  • Ann-Jeanette Vasko
    • 2
  • Karyn Monte
    • 3
  1. 1.ConvaTecA Bristol-Myers Squibb CompanySkillman
  2. 2.ConvaTecA Bristol-Meyers Squibb CompanySkillman
  3. 3.ConvaTecA Bristol-Meyers Squibb CompanySkillman

Personalised recommendations