I have a patient who had a failed mesh placement and a panniculectomy and who has developed at least three separate fistulas with a very large amount of output (3-4 L/24 hrs). Any suggestions? I am using an Eakin wound management pouch hooked up to wall suction.
A Prospective, Multicenter Study to Validate Use of the PUSH© in Patients with Diabetic, Venous, and Pressure Ulcers
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36 Abstract: Monitoring wound progress is essential for evaluating and documenting treatment outcomes. The Pressure Ulcer Scale for Healing (PUSH) was developed to track pressure ulcer (PU) progress but information about its utility for other types of chronic wounds is limited. A 10-month, descriptive, multicenter study was conducted to examine the responsiveness and concurrent validity of the PUSH when used to monitor wound changes in diabetic foot (DFU), venous leg (VLU), and PU. Using a convenience sample of participants (n = 98, mean age 60 [range 20 to 89] years, the majority [85%] male), PUSH score and acetate wound surface area tracings were obtained at baseline and approximately 4 weeks later from 47 Stage II to Stage IV PU, 23 VLU, and 28 patients with a DFU. After an average of 32 days, wound surface area, total PUSH scores, and individual PUSH component scores decreased significantly between baseline and follow-up (P = 0.000). The mean PUSH score change was significantly different between healing and nonhealing wounds (P = 0.000). A strong relationship (r = .66) was found between total PUSH score and surface area. Results suggest the PUSH tool is a valid, responsive, evaluative tool to monitor and document wound progress of PU, VLU, and DFU. Additional studies to assess use of this tool for DFU and to ascertain the predictive validity of the PUSH tool are warranted.
Please address correspondence to: Pamela E. Houghton, PT, PhD, School of Physical Therapy, University of Western Ontario, Room 1588 Elborn College, 1201 Western Road, London, Ontario N6G 1H1, Canada; email: phoughto@uwo.ca.
Measuring progress toward wound healing is an important component of chronic ulcer treatment programs — it ensures the wound care clinician that appropriate wound management is in place and allows the interdisciplinary team to reassess the treatment plan. The Pressure Ulcer Scale for Healing (PUSH©, National Pressure Ulcer Advisory Panel, NPUAP1) was developed as a generic tool to provide a consistent, evidence-based tracking system for reporting wound healing progression or regression. Originally developed to prevent backstaging of PU, the tool consists of three parameters: wound surface area, exudate amount, and tissue type.1
Literature Review
Thomas et al2 completed a retrospective study of 37 patients with PU using a research database that included numerous variables associated with wound healing to test hypothetical models of healing. One ulcer was selected per participant; most were Stage III (46%) or Stage IV (35%). PU were assessed every 2 weeks for 8 weeks. Content validity was established by review of the literature and expert opinion. As a result, ulcer surface area, exudate characteristics, and surface appearance were used as key elements to measure wound healing. Principal component analysis using retrospective chart data indicated these parameters defined the best model of healing (P <0.01).3 The authors concluded that the PUSH tool had content validity, correlation validity, prospective validity, and was sensitive to change. 
Stotts et al’s4 two retrospective chart review studies further validated the PUSH tool to track healing of Stage II through Stage IV PU. The first study included 103 adults with a Stage II (34.9%), Stage III (47.4%), or Stage IV (11.0%) PU from 10 different sites assessed weekly over 10 weeks. Principal component analysis confirmed the PUSH variables of surface area, exudate amount, and surface appearance provided the best model of healing and accounted for 58% to 74% of the variation across the 10 weeks.
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