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Physical Exam

Wound Assessment – Type & Measurements

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Length x Width (cm)

Depth (cm)

Wound Bed Characteristics: Document composition of the wound bed (goal is ~100% clean granulation for graft placement):

Wound Bed Characteristics

granulation

slough/Fibrin

eschar/Necrotic tissue

Epithelial tissue (new skin at edges)

Hypergranulation (if any)

Percentage Granulation

Percentage Slough/Fibrin

Percentage eschar/Necrotic tissue

Percentage Epithelial tissue (new skin at edges)

Percentage Hypergranulation (if any)

Periwound Skin

Abnormal

Blistering eruption

Bruising

Calloused

Dry

Edema

Erythema

Excoriation

Fragile

Hyperkeratosis

Indurated

Maceration

Normal

Scaly

Site specific eczema

Describe the wound Edges

Attached

Not-attached

Rolled

Epithelialized

Wound Drainage

Clear, thin, watery (serous)
Thick, yellow/green/grey (purulent)
Bloody (sanguineous)
Thin, pink, watery (serosanguinous)
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Is Undermining Present?

Yes

No

Describe Undermining?

Do you suspect this wound of being infected?

Yes

No

Describe Infection?

Is Tunneling Present?

Yes

No

Describe Tunneling

Wound Odor

None

Malodorous

Pain Level

Vitals Taken

Yes

No

Wound Stages

Stage 1

Stage 2

Stage 3

Stage 4

Vitals Taken show all

BP
HR
TEMP
SVO2
ABI
Posterior tibialis
Dorsal Pedis

Vascular Test Done

Yes

No

Vascular Test Type

Pulses Status

Palpable
Diminished
Not Palpable
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Vascular Perfused

Yes

No