Wound Assessment Using the LADD SECO Model

Bryan LevayHSCI 5108: Instructional Media

Summer 2013

Overview

• Importance of wound care• Lecture• Describe wounds• Activity• Evaluation

Importance of wound care

• 15-25% of all diabetics will have an ulcer in their lifetime

• Recurrence rate 40%• Amputation– 85% of lower-extremity amputation are preceded by an

ulcer– 5-year mortality rate following a BKA is ~50%– Amputation have varying psychosocial issues

accompanying– Most amputations are preventable

Diabetic foot ulceration

• Neuropathic– Neuropathy– Deformity – Minor trauma

http://www.google.com/url?sa=i&rct=j&q=&source=images&cd=&cad=rja&docid=5WWAQUHnqiWP5M&tbnid=IRw7Ps56D5DayM:&ved=0CAUQjRw&url=http%3A%2F%2Fhealthylogica.blogspot.com%2F2012%2F07%2Fhow-to-prevent-onset-of-diabetic-foot.html&ei=qN21UcKeBYbSyAGlm4GwAQ&bvm=bv.47534661,d.aWc&psig=AFQjCNFBCGpwm1K3C9kDBScAKMg4RE13XQ&ust=1370959653987682

Summary

• 2nd-year DO & DPM students– Basic knowledge from previous courses

• Objectives– Identify DFU from non-DFU– Verbally and transcribe the wound description with

LADD SECO criteria– Be able to explain 7 of 8 components of LADD SECO

• Technologies– Computer, MS Word, PPT, Blackboard access

Learning module

• 2-hour lecture– Basic information– Intro to LADD SECO

• 2-hour activity– 5-item exercise packet– Evaluation

Lecture

• Traditional learning • 2-hour• Lecture hall 2 of the

HEC at WesternU• Certified Wound

Specialist• Reinforce previous

knowledge• Introduce LADD SECO

http://www.google.com/imgres?q=lecture&um=1&safe=active&client=safari&rls=en&hl=en&biw=1136&bih=712&tbm=isch&tbnid=Uzj6-RhpnC4shM:&imgrefurl=http://www.123rf.com/photo_16614791_orange-cartoon-characters-sit-in-on-a-lecture.html&docid=xWwpmLpX_iephM&imgurl=http://us.123rf.com/400wm/400/400/limbi007/limbi0071211/limbi007121100130/16614791-orange-cartoon-characters-sit-in-on-a-lecture.jpg&w=1200&h=849&ei=6d21UcC0M4PfyQGkwoG4Dg&zoom=1&ved=1t:3588,r:64,s:0,i:280&iact=rc&dur=391&page=4&tbnh=176&tbnw=232&start=50&ndsp=18&tx=93&ty=104

LADD SECO

• Location• Aspect• Dimensions• Drainage

• Shape• Edge• Color• Other

Location

• Where is the wound located?

http://www.google.com/imgres?q=anatomical+position&um=1&hl=en&safe=active&client=safari&rls=en&biw=1179&bih=723&tbm=isch&tbnid=w_CNJwmb0KaW6M:&imgrefurl=http://www.cafepress.com/%2Banatomical_position_artwork_large_poster,664782979&docid=R8XU5XjP3Eg2pM&imgurl=http://images.cpcache.com/merchandise/514_400x400_NoPeel.jpg%253Fregion%253Dname:FrontCenter,id:69332470,w:16&w=400&h=400&ei=31ZcUcrULIn8iAequYDIDQ&zoom=1&ved=1t:3588,r:43,s:0,i:218&iact=rc&dur=495&page=2&tbnh=172&tbnw=210&start=21&ndsp=27&tx=111&ty=114

Aspect

• What aspect of the body is it located?• Example: Inside, outside, front, rear• Like location, it distinguishes position

http://www.google.com/url?sa=i&rct=j&q=views+from+different+angles&source=images&cd=&docid=XRsFkfXk4ShNRM&tbnid=WDoiN7oqcOuxzM:&ved=&url=http%3A%2F%2Fcghub.com%2Fforum%2Fshowthread.php%3Fp%3D151622&ei=PlVcUe-CI6OriAfb5oHoAg&bvm=bv.44697112,d.aGc&psig=AFQjCNGzvb9-1E8hoVgopZaKkehdeedNCw&ust=1365092030944569

Drainage

• Is there any drainage coming out?• Example: purulent, serous, blood

http://www.google.com/url?sa=i&rct=j&q=purulent+discharge&source=images&cd=&docid=ZYj8KGfawdI-qM&tbnid=ymr9oyULXt1NHM:&ved=0CAUQjRw&url=http%3A%2F%2Fdermatologyoasis.blogspot.com%2F2012_05_01_archive.html&ei=rG9cUZ7UAuquiQeM2YGwCg&bvm=bv.44697112,d.aGc&psig=AFQjCNEL9euCuqyeFIeop9Zibe52hVneVQ&ust=1365098743919879

http://www.google.com/url?sa=i&rct=j&q=weeping+wound+venous+ulcer&source=images&cd=&docid=4UAVnwaAg_dwqM&tbnid=VtJiVBp1fSVS1M:&ved=0CAUQjRw&url=http%3A%2F%2Fwww.lymphedemapeople.com%2Fthesite%2Fedema_chronic_venous_insufficiency.htm&ei=13BcUZTxE8ujiAfG1IGQAg&bvm=bv.44697112,d.aGc&psig=AFQjCNE_Ggdh55QilrI0nuwdnd2mVprECw&ust=1365099005423999

http://www.google.com/url?sa=i&rct=j&q=weeping+wound+venous+ulcer&source=images&cd=&docid=uj0onwI6ihIbiM&tbnid=kik_pTRdGHGAoM:&ved=&url=http%3A%2F%2Fwww.worldwidewounds.com%2F2006%2Fseptember%2FHarker%2FWound-Healing-Complications-Limb-Amputation.html&ei=fXBcUaPLBa2SiQezvIH4CQ&bvm=bv.44697112,d.aGc&psig=AFQjCNE_Ggdh55QilrI0nuwdnd2mVprECw&ust=1365099005423999

Dimensions

• What are the dimensions of the wound?• Length x Width x Depth• Metric only

http://www.google.com/url?sa=i&rct=j&q=measuring+a+wound&source=images&cd=&docid=MV-nhJ1cE3MZ9M&tbnid=sx8JKbQ5v2qwZM:&ved=&url=http%3A%2F%2Fwww.woundstick.com%2Fwoundstick_20cm_product_page.htm&ei=IFdcUcfqOuPMiAe8moHICg&bvm=bv.44697112,d.aGc&psig=AFQjCNEXsIT8lQujSLzpAd4gXCSfvnOoxQ&ust=1365092513327661

Shape

• How is the wound shaped?• Example: circular, linear, irregular

http://www.google.com/url?sa=i&rct=j&q=irregular+shaped+ulcer&source=images&cd=&docid=cBUvVZzqOrb4HM&tbnid=QY7dy9Nuw3SNXM:&ved=0CAUQjRw&url=http%3A%2F%2Fwww.podiatrytoday.com%2Fcase-studies-unusual-wounds%3Fpage%3D3&ei=a15cUZbvFuWTiAfNo4GoDQ&bvm=bv.44697112,d.aGc&psig=AFQjCNGH16I7SCYPPn0bCTtQE9GH--5xYA&ust=1365094360440745

http://www.google.com/url?sa=i&rct=j&q=foot+chainsaw+wound&source=images&cd=&docid=0mLF3V03ARJKmM&tbnid=RjF9mtgaGV777M:&ved=&url=http%3A%2F%2Fwww.bchw.org%2FTech%2520tips%2FSawCertification%2FChain%2520Saw%2520Injuries.htm&ei=HelZUb2YGqzVigLm94DICA&bvm=bv.44442042,d.cGE&psig=AFQjCNEROUCQqJQX-eweOXLExzrydsulkw&ust=1364933277917644

http://www.google.com/imgres?q=diabetic+ulcer&um=1&hl=en&safe=active&client=safari&rls=en&biw=1179&bih=723&tbm=isch&tbnid=IRw7Ps56D5DayM:&imgrefurl=http://healthylogica.blogspot.com/2012/07/how-to-prevent-onset-of-diabetic-foot.html&docid=5WWAQUHnqiWP5M&imgurl=http://1.bp.blogspot.com/-QUVSBwO1d0I/T_VsHpitZqI/AAAAAAAABiM/kWfCftbE2xc/s1600/How%252BTo%252BPrevent%252BThe%252BOnset%252BOf%252BDiabetic%252BFoot%252BUlcers.jpg&w=800&h=600&ei=D19cUfybOIj_iAeJjIHoDA&zoom=1&ved=1t:3588,r:5,s:0,i:96&iact=rc&dur=827&page=1&tbnh=180&tbnw=242&start=0&ndsp=15&tx=136&ty=102

Edge

• How does the wound edges appear?• Example: macerated, callused, necrotic

http://www.google.com/url?sa=i&rct=j&q=macerated+wound&source=images&cd=&docid=16femcYuqFNmQM&tbnid=Rnvp3I8cXNx9ZM:&ved=0CAUQjRw&url=http%3A%2F%2Fwocn.confex.com%2Fwocn%2F2007AM%2Ftechprogram%2FP2467.HTM&ei=G2FcUf2_GYWfiAfo6oCgAQ&bvm=bv.44697112,d.aGc&psig=AFQjCNFCT-_HFJHCXAiIuczM1cKIz9btcQ&ust=1365095054762175

http://www.google.com/url?sa=i&rct=j&q=hyperkeratotic+rim+ulcer&source=images&cd=&docid=LgvOhMrukma5BM&tbnid=cOUolUH8FVAN3M:&ved=0CAUQjRw&url=http%3A%2F%2Fwww.studyblue.com%2Fnotes%2Fnote%2Fn%2Fskin%2Fdeck%2F5281900&ei=7WFcUcHtCOX_iAfxyoHIBw&bvm=bv.44697112,d.aGc&psig=AFQjCNGjLNnoKcbBVq-Hc6TWqrpYnZWlHg&ust=1365095263991005

http://www.google.com/url?sa=i&rct=j&q=necrotic+ulcer&source=images&cd=&docid=u_4IxDraUJXYdM&tbnid=Vk6kEM4qxCX5UM:&ved=0CAUQjRw&url=http%3A%2F%2Fopeni.nlm.nih.gov%2Fdetailedresult.php%3Fimg%3D3105064_pone.0020492.g002%26req%3D4&ei=gWJcUfyICs-5iAeIwYGADA&bvm=bv.44697112,d.aGc&psig=AFQjCNFyoy0NiqcBL7eu-e-nmi_wPituWw&ust=1365095397186211

Color

• What is the color of the wound base?• Example: Red, white, yellow, black

http://www.google.com/url?sa=i&rct=j&q=venous+ulcer&source=images&cd=&docid=-jNJwK6c6lT2OM&tbnid=ioD9PfVud7j0aM:&ved=0CAUQjRw&url=http%3A%2F%2Fpics8.this-pic.com%2Fkey%2Fdifference%2520between%2520arterial%2520venous%2520ulcers&ei=t_VZUYvTD4epkAXHkYGADw&bvm=bv.44442042,d.dGI&psig=AFQjCNHVgEv36weHpBuYG-OFCPGkjEoVGA&ust=1364936195878872

http://www.google.com/url?sa=i&rct=j&q=ulcer+color&source=images&cd=&docid=H8aN--s8OMZAxM&tbnid=CXePJOwpqHLDCM:&ved=&url=http%3A%2F%2Fwww.skinsight.com%2Fadult%2FaphthousUlcerCankerSore.htm&ei=-WNcUenbFKiiiAff34GYBg&bvm=bv.44697112,d.aGc&psig=AFQjCNFjqwOKYBrw_l6Nn165Gw24E3bUVA&ust=1365095801684734

http://www.google.com/url?sa=i&rct=j&q=yellow+wound&source=images&cd=&docid=sP-KGNu6izdraM&tbnid=1gShQ_ETkvAVpM:&ved=0CAUQjRw&url=http%3A%2F%2Fwww.worldwidewounds.com%2F1997%2Fjuly%2FThomas-Guide%2FDress-Select.html&ei=_2VcUZfLMubqiAfQrIGIBQ&bvm=bv.44697112,d.aGc&psig=AFQjCNHJzccSGyEBZN9AVB4cZc_Q48tQ_Q&ust=1365096312735874

http://www.google.com/url?sa=i&rct=j&q=black+wound&source=images&cd=&docid=sP-KGNu6izdraM&tbnid=b4m1zyaq2Tsk1M:&ved=0CAUQjRw&url=http%3A%2F%2Fwww.worldwidewounds.com%2F1997%2Fjuly%2FThomas-Guide%2FDress-Select.html&ei=n2ZcUYD7Ke2tiQf5u4HIDA&bvm=bv.44697112,d.aGc&psig=AFQjCNFl771nUPqSEzYgbLW2fq49PZqu0g&ust=1365096465479103

Other

• Other things you notice?– Warmth?– Odor?– Satellite wounds?– Tunneling?– Periwound area?

Activity

• 2-hour session• 6-8 students per break out room– 1-2 DPM, 5-6 DO

• 5 cases with image• Individual needs to complete• Rounding faculty will provide assistance

Evaluation

Student feedback

References• American Diabetes Association. (2013). Economic Costs of Diabetes in U.S. in 2012. Diabetes Care, 36(4), 1033-1046. doi:

10.2337/dc12-2625• Armstrong, D. G., Nguyen, H. C., Lavery, L. A., van Schie, C. H. M., Boulton, A. J. M., & Harkless, L. B. (2001). Off-loading the diabetic

foot wound: A randomized clinical trial. Diabetes Care, 24(6), 1019-1022. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11375363

• Bryant, R. A., & Nix, D. P. (Eds.). (2003). Acute & chronic wounds: Current management concepts (3 ed.). St. Louis, Missouri: Mosby Elsevier.

• Bumpus, K., & Maier, M. A. (2013). The ABC’s of wound care. Current Cardiology Reports. Advance online publication. doi: 10.1007/s11886-013-0346-6

• Carls, G. S., Gibson, T. B., Driver, V. R., Wrobel, J. S., Garoufalis, M. G., DeFrancis, R. R., . . . . Christina, J. R. The economic value of specialized lower-extremity medical care by podiatric physicians in the treatment of diabetic foot ulcers. Journal of the American Podiatric Medical Association, 101(2), 93-115. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21406693

• Cavanagh, P. R., & Bus, S. A. (2010). Off-loading the diabetic foot for ulcer prevention and healing (Supplemental material). Plastic and Reconstructive Surgery, 127(1S), 248S-256S. doi: 10.1097/PRS.0b013e318202484

• Harkless, L., & Holmes, C. (2004). Linking risk factors: The role of history in predicting outcome. The Diabetic Foot, 7(3), 114-122. Retrieved from http://www.highbeam.com/doc/1G1-124137347.html

• Leung, P. C. (2007). Diabetic foot ulcers – a comprehensive review. Surgeon, 5(4), 219-231. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/17849958

• Ramsey, S. D., Newton, K., Blough, D., McCulloch, D. K., Sandhu, N., Reiber, G. E., & Wagner, E. H. (1999). Incidence, outcomes, and cost of foot ulcers in patients with diabetics. Diabetes Care, 22(3), 382-387. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10097914

• Rhim, B., & Harkless, L. (2012). Prevention: Can we stop problems before they arise? Seminars in Vascular Surgery, 25(2), 122-128. doi: 10.1053/j.semvascsurg.2012.05.002

Questions?