Deep Tissue Injury Measurement and Assessment
Yes, deep tissue injuries must be measured systematically using specific wound parameters including size, depth, and undermining, as these measurements are critical for tracking progression and guiding treatment decisions. 1
Required Measurement Parameters
Deep tissue injuries should be documented using the following quantitative metrics:
- Size measurement in cm²: Categorized as <1 (score 0), 1-2 (score 1), >2-5 (score 3), >5-10 (score 6), >10-30 (score 8), or >30 (score 10) 1
- Depth measurement in mm: Categorized as <5 (score 0), 5-9 (score 3), 10-20 (score 7), or >20 (score 10) 1
- Undermining in mm: Categorized as <2 (score 3), 2-5 (score 5), or >5 (score 8) 1
These measurements form part of the validated DFI Wound Score system, which has demonstrated good internal consistency and significant correlation with clinical outcomes in large prospective trials. 1
Clinical Assessment Beyond Measurement
In addition to physical measurements, clinicians must assess for signs of inflammation including erythema, warmth, tenderness, pain, induration, and presence of purulent or nonpurulent discharge. 1 The Infectious Diseases Society of America recommends documenting at least 2 classic signs of inflammation to diagnose infection in tissue injuries. 1
Common Anatomical Locations
Deep tissue injuries most commonly occur at:
Advanced Detection Methods
Thermographic Imaging
Skin surface temperature monitoring can detect incipient deep tissue injury before visible changes appear. 3 Quantitative heat transfer modeling demonstrates:
- Initial inflammation phase: Surface temperature increases approximately 0.5°C 3
- Persistent ischemia phase: Surface temperature decreases approximately 0.2°C 3
These temperature differences are sufficiently large for detection by thermographic imaging, enabling early intervention before surface manifestation. 3
Critical Clinical Pitfalls
The hallmark of deep tissue injury is rapid deterioration despite appropriate preventive interventions, and visual assessment alone may fail to identify patients at risk. 4, 5 Deep tissue injuries begin in muscle closest to bone and may not be visible in early stages, making surface inspection inadequate. 4
Risk Factors Associated with Poor Outcomes
Factors significantly associated with progression to full-thickness injury include:
- Mechanical ventilation (P = .01) 2
- Feeding tube use (P = .02) 2
- Anemia (P = .005) 2
- Vasopressor use (P = .003) 2
- Prolonged hospital length of stay (median 23 days, P <.001) 2
- ICU admission (median 12 days, P = .03) 2
Treatment Approach
Early and frequent assessment with timely intervention may prevent deep tissue injury progression, as progression to full-thickness injury is not inevitable. 2 The treatment algorithm should prioritize:
- Immediate pressure relief at identified injury sites 4
- Serial measurements using the standardized parameters above to track progression 1
- Low-air-loss support surfaces for high-risk patients (P = .005 for outcome differences) 2
- Correction of modifiable risk factors including anemia and nutritional deficits 2
Documentation Requirements
Explicit definitions and numerical scoring of wound parameters should be used rather than subjective descriptions. 1 This standardized approach allows for: