title: Surgical pathology to describe the clinical margin of debridement of chronic wounds using a wound electronic medical record.
abstract: BACKGROUND
  Chronic wounds, including diabetic foot ulcers (DFU), pressure ulcers (PU), and venous ulcers (VU) result from multiple physiologic impairments. Operative debridement is a mainstay of treatment to remove nonviable tissue and to stimulate wound healing. Unlike tumor resection, however, operative wound specimens are not routinely sent for pathology. The objective of this study was to describe the pathology present in chronic wounds.
  
  
  METHODS
  Pathology reports of the skin edge and wound base from 397 initial debridements in 336 consecutive patients with chronic wounds were retrospectively reviewed. All data were entered and stored in a Wound Electronic Medical Record. Pathology data were extracted from the Wound Electronic Medical Record, coded, and quantified.
  
  
  RESULTS
  Up to 15 distinct histopathologic findings across 7 tissue types were observed after review of pathology reports from chronic wounds. Specifically, the pathology of epidermis revealed hyperkeratosis: 66% in DFUs, 31% in PUs, and 29% in VUs. Dermal pathology revealed fibrosis in 49% of DFUs, 30% of PUs, and 15% of VUs. Wound bed pathology revealed necrosis in the subcutaneous tissue in 67% of DFUs, 55% of PUs, and 19% of VUs. Fibrosis was reported in between 19% and 52% of all wound types. Acute osteomyelitis was present in 39% of DFUs, 33% of PUs, and 29% of VUs.
  
  
  CONCLUSIONS
  This observational study of the histopathology of initial surgical debridement of chronic wounds revealed a wide range of findings across multiple tissue levels. Although certain findings such as osteomyelitis and gangrene have been shown to directly relate to impaired wound healing and amputation, other findings require additional investigation. To rigorously define a margin of debridement, a prospective study relating histopathology and clinical outcomes such as healing rates and amputation is needed.
authors.affiliation: Helen and Martin Kimmel Wound Center, Division of Wound Healing and Regenerative Medicine, Department of Surgery, New York University School of Medicine, New York, NY 10016, USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Golinko
authors.forename: Renata
authors.initials: R
authors.lastname: Joffe
authors.forename: David
authors.initials: D
authors.lastname: de Vinck
authors.forename: Eashwar
authors.initials: E
authors.lastname: Chandrasekaran
authors.forename: Olivera
authors.initials: O
authors.lastname: Stojadinovic
authors.forename: Stephan
authors.initials: S
authors.lastname: Barrientos
authors.forename: Sasa
authors.initials: S
authors.lastname: Vukelic
authors.forename: Marjana
authors.initials: M
authors.lastname: Tomic-Canic
authors.forename: Harold
authors.initials: H
authors.lastname: Brem
mesh_terms: D002908:Chronic Disease; D003646:Debridement / Q000379:methods*; D006801:Humans; D016347:Medical Records Systems, Computerized; D010043:Outcome and Process Assessment, Health Care; D011785:Quality Assurance, Health Care; D014947:Wounds and Injuries / Q000473:pathology* / Q000601:surgery*