Monday, March 22, 2010

When and How to Perform a Biopsy on a Chronic Wound – an Article Review

Super nice article on in the March 2010 issue of Advances in Skin & Wound Care (full reference below) on a very important topic. Most of us may know when a biopsy should be done of a chronic wound, but most of us are not trained in how to do one. Different areas of the chronic wound are best biopsied depending on the suspected diagnosis.

The article clearly lists the indications and contraindications for a wound biopsy.

This is probably the most important question for healthcare professionals dealing with wound care. Benefits of biopsy in a wound can be divided into 3 groups that reflect the 3 main causes of wounds in general:
1. to diagnose the etiology of a wound (wound edge),
2. to rule out malignancy (wound edge), and
3. to obtain tissue for bacterial quantitative culture or to identify an infecting organism.

The next question to consider is: Are there any contraindications to wound biopsy?
There are 2 relative contraindications to wound biopsy11:
1. blood dyscrasia with the risk of uncontrollable bleeding
2. venous congestion and extremely vascular wounds (arterial insufficiency) in a setting that access to care is limited or the biopsy wound is unlikely to heal.

There is an extensive table listing the preferred biopsy site for different suspected pathologies. Some of those listed include:

  • Basal cell carcinoma (superficial) -- It is best to do a shave or curette biopsy of the rolled margin.
  • Basal cell carcinoma (other variants) – It is best to do a deep punch or excisional biopsy of the base or wound edge.
  • Squamous cell carcinoma -- It is best to do a punch or excisional biopsy of the deep wound base.
  • Pyoderma gangrenosum -- It is best to do a punch or deep wedge biopsy of the wound ulcer border and center. The biopsy should include cultures to rule out infection.
  • Vasculitis (large vessel) – It is best to do a deep incisional wedge biopsy of the center of the lesion. DIF (direct immunofluorescence) should be considered.

The article gives clear instructions on how to perform three different types of wound biopsies: shave, punch, and elliptical deep excisional.

I recommend this article to anyone (family physicians, dermatologists, plastic surgeons, etc) who take care of chronic wounds.

REFERENCE

When and How to Perform a Biopsy on a Chronic Wound; Advances in Skin & Wound Care 23(3):132-140, March 2010; Alavi, Afsaneh; Niakosari, Firouzeh; Sibbald, R. Gary; doi: 10.1097/01.ASW.0000363515.09394.66

3 comments:

StorytellERdoc said...

Hi Ramona!
From an ER standpoint, I think I will leave these biopsies to you, thank you very much! LOL

Hope this finds you well.
Jim

DBenzil said...

Being a neurosurgeon, I too will leave these to a pro but the summary does help me know when to send on for further eval. Thanks for the great summary.

CTA Lab - Direct Immunoflurescence said...

Thank you!! Very helpful post, we will direct physicians to this if they have questions about wound care biopsies. Regarding the DIF testing, we have a helpful list of how to obtain Direct Immunofluorescence biopsies for Vasculitis as well as other diseases: Direct Immunoflurescence (DIF) Biopsy Info - CTA Lab.