How do you document a diabetic foot wound with 100% eschar?

Documentation of a Diabetic Foot Wound with 100% Eschar

When documenting a diabetic foot wound with 100% eschar, you should accurately record the wound characteristics including size, depth, location, and presence of eschar, but avoid debridement if the wound is primarily ischemic as this may be contraindicated. 1

Assessment and Documentation Components

Initial Wound Evaluation

• Document the exact location of the wound on the foot
• Measure and record the wound size (length, width, and depth in cm)
• Note that the wound bed is covered with 100% eschar (dry, necrotic tissue)
• Document the color of the eschar (black, brown, or gray)
• Record the consistency of the eschar (hard/leathery or soft)
• Document the extent of any surrounding cellulitis or erythema in centimeters 1

Vascular Assessment

• Document the presence or absence of pedal pulses (dorsalis pedis and posterior tibial)
• Record ankle-brachial index (ABI) if available (note: values may be falsely elevated in diabetic patients due to arterial calcification)
• Note any signs of ischemia that might contraindicate debridement 1

Infection Assessment

• Document presence or absence of:
  • Purulent drainage
  • Odor
  • Warmth
  • Pain/tenderness (may be absent in neuropathic patients)
  • Induration
  • Surrounding erythema 1

Neuropathy Assessment

• Document results of protective sensation testing using 10g monofilament 1
• Note any foot deformities that may contribute to wound development 1

Special Considerations for Eschar Documentation

Determining Wound Type

• Classify the wound as neuropathic, neuro-ischemic, or purely ischemic based on your assessment 1
• This classification is crucial as it determines whether debridement is appropriate

Debridement Considerations

• Important caveat: Debridement may be relatively contraindicated in wounds that are primarily ischemic 1
• Document your decision regarding debridement based on vascular assessment
• If the wound appears to be primarily ischemic with 100% eschar, note that debridement is being deferred pending vascular evaluation 1

Wound Probing

• If debridement is not performed due to ischemic concerns, document that wound probing was limited or not performed to avoid disrupting the eschar in an ischemic wound
• If safe to do so, use a sterile, blunt metal probe to assess wound depth and note if bone is palpable (which would suggest osteomyelitis) 1

Documentation Example

"3 cm × 2 cm × depth not assessed wound on plantar surface of right foot under 1st metatarsal head. Wound bed 100% covered with adherent black eschar. No purulent drainage, no odor. Surrounding erythema extending 0.5 cm from wound edge. No fluctuance. Diminished dorsalis pedis and posterior tibial pulses. Patient reports history of peripheral arterial disease with ABI of 0.6 measured 3 months ago. Protective sensation absent on monofilament testing. Due to concerns for inadequate arterial perfusion, debridement of eschar deferred pending vascular surgery consultation. Wound dressed with dry sterile dressing."

Follow-up Recommendations

• Document the plan for follow-up, including:
  • Vascular assessment if ischemia is suspected
  • Wound care instructions
  • Frequency of dressing changes
  • Need for offloading 1

Remember that accurate documentation of a diabetic foot wound with 100% eschar is essential for proper wound management and communication between healthcare providers. The decision to debride or preserve the eschar depends primarily on the vascular status of the foot, and this clinical decision should be clearly documented.