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Wound measurement question

Posted
by kristin10 kristin10 (New) New

Hi all,

When measuring a wound, is the length always the longest measurement of the wound? I’ve been told to measure length the 12 and 6 positions of a clock but then getting confused hearing longest length of wound.

I've attached a picture to try and describe what I’m talking about. For this picture, would the length still be from toes to heel even though the width will clearly be larger if width is measured at the 3 and 9 o clock positions?

F6F5FE26-8F8E-4CB6-A635-B097D512E198.jpeg

dianah, ADN

Specializes in Cath Lab/Radiology. Has 46 years experience.

Moved to Wound/Ostomy/Continence area.

I was taught to measure anatomically, if that makes sense? Length would be 12 to 6, head to toe. Width 3 to 9.

But not everyone measures that way so there is definitely discrepancies in measurements.

GracefullyGritty, LPN

Specializes in wound care/rehabilitative care. Has 5 years experience.

Yes definitely measured it correctly. I was even taught to stay at 12-6 and 3-9 if the wound is more like diagonal.........but I've had nurses with many more years than myself do that too ?? If I am floated to a different center it is nice to look at the previous measurement and kinda stay within that parameter.

It would depend on the policy at the center. Due to so many abnormally shaped wounds we tend to measure the longest and widest areas (head to toe, should to shoulder instead of exactly the 12 to 6, 3 to 9). Feet are funky because the toes are actually at the 6 o'clock position and the heel is at the 12 o'clock position just like a ballerina or a skeleton the toes would be closest to the ground. It is important when you need to document undermining which is common in foot wound due to the shearing forces and tunneling which tends to occur along suture lines.