o Camera (as per agency policy). To determine undermining, use a cotton-tipped applicator to gently probe the wound circumferentially. The biggest difference between sinus tracts or tunneling and undermining is that tunneling and sinus tracts are unidirectional, whereas undermining may occur in more than one direction. How are you differentiating the “big three”? ABIs: Do you or don’t you? Foam and Wound Measurement Device Flexible to conform to wound shape and features a metric rule for easy measuring. Hi Catherine, As an RN dedicated to treating wounds, I highly recommend wound care certification. 12 Assess wound characteristics to determine appropriate interventions. Tunneling can occur in any wound, but it occurs most commonly in surgical wounds and wounds occurring from a neuropathic cause. The measurement of a wound, and the plotting of its size over time, is the only estimate that can be used to accurately predict wound healing. Reference: Wound Assessment Guideline Decision Support Tool (DST). For detailed information visit our wound care certification courses page, or contact us directly. Think of undermining like this: the wound is larger than the "hole" or entrance of the wound. Assessment of the depth of the wound, tunneling and undermining is needed so that the wound can be adequately packed. Michael N. Desvigne, MD, FACS, CWS, FACCWS, Kevin F. Ackermann, Vice President of Healthcare, Medela, http://www.ncnm.edu/images/CE/WCEI_outline.pdf, http://www.nursingcenter.com/lnc/static?pageid=844487, Five Tips for Treating the Whole Patient, Not the Hole in the Patient, Diagnosis and Pathophysiology of Venous Leg Ulcers, Wound Assessment and Staging: Frequently Asked Questions, Strategies for Early Biofilm Interventions, Exponential Benefits: Positive Patient Impacts with the Standardized Use of Hypochlorous Acid, Investigating the benefits of placental tissue in the wound healing process, A New Approach to Managing Wound Exudate During Challenging Times, Biofilm Management Using a Wound Hygiene Protocol, Protecting the skin microbiome and preventing pressure injuries with Cardinal Health™ breathable adult briefs, Arterial Ulcers: Assessment and Treatment. Undermining generally includes a wider area of tissue than tunneling. Progressing in a clockwise direction, document and measure the deepest sites all around the wound edges where undermining occurs. WoundEducators.com | Online Wound Care Certification Courses. For detailed information visit our wound care certification courses page, or contact us directly. For example: 2 cm. Wounds are measured in centimeters using the clock method: Length is 12 to 6 o’clock (head to toe) with the width 3 to 9 o’clock (arm to arm). Using ranges for undermining (for instance, undermining of 1.5 cm noted from 12 – 3 o’clock) tends to be less time-consuming than documenting undermining at each individual hour. A packing count of all dressings used to fill the wound space is to be done for any wound where the depth or the wound bed, undermining or sinus tract is 1 cm or greater. •Undermining or tunneling •Necrotic tissue •Granulation tissue •Epithelium •Exudate Wound Characteristics. Because tunneling and undermining are not readily visible, all wounds must he thoroughly probed to identify the full extent of tissue destruction. One must be careful not to pull on the skin flaps and displace the actual measurement. When underminingis present, the direction (using the clock method) and extent (measured in cms) should be documented. MEASURE encapsulates key wound parameters that should be addressed in the assessment and management of chronic wounds: Measure (length, width, depth, and area), Exudate (quantity and quality), Appearance (wound bed, including tissue type and amount), Suffering (pain type and level), Undermining (presence or absence), Reevaluate (monitoring of all parameters regularly), and Edge (condition of … The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies. Sign up for our newsletter and enjoy a Free Preview of our Wound Care Certification Course! Getting Started: Wound Care Certification. Undermining To measure undermining, insert a saline-moistened cotton-tip applicator into the undermined area and grasp the applicator where it meets the wound’s edge. Undermining is measured directly under the wound edge with a probe held almost parallel to the wound surface, stopping when resistance is felt. Gently measure deepest portion of the wound using a sterile cotton-tipped applicator or measurement device “straight in” (Figure 5) The depth is measured when the applicator shaft emerges at skin level. pg 52-53. Nurses must also document the location and depth of any tunneling or undermining. Once the length, width and depth of the wound have been measured, it is important to then record any evidence of undermining and what the dimensions of that undermining are. • Note: Undermining is defined as 1.0 to 1.4 cm, tunneling as greater than 1.4 cm. About The Author Areas of undermining (extension of the wound under edges) and tunnelling (narrow passageway beneath intact skin) are measured by gently probing the NS moistened sterile applicator and compared to length on disposable rulers available in your wound care supply boxes. Upper Saddle River, New Jersey. For more information about the ABWM exam eligibility requirements please visit: https://woundeducators.com/wound-certification/abwm. Meyers, B. Here is the wound care plan that was used for treatment: 1. Tunneling and undermining are not always easily visualized, therefore all wounds should be thoroughly probed in order to determine the full extent of tissue damage. Image Credit: Medetec (http://www.medetec.co.uk/), Sources Your online source for wound care certification. In determining undermining, gently probe the wound with your cotton-tipped applicator circumferentially around the wound. Blog, Wound Care Advisor WCA Posts navigation. The distance from the probe tip to the point at which the probe is level with the wound edge represents the amount of undermining present. Measure depth by inserting a cotton-tip applicator into the area of undermining and grasping the applicator where it meets the wound edge. ... An example of this measurement is 4x3x2 with 2cm of undermining from 2 O'clock to 4 O'clock. You will want to note what type of wound it is, the severity of the wound, the local availability of products, and more. A critical step in the wound assessment is measurement. Laurie Swezey, founder and president of WoundEducators.com, has been a Registered Nurse for more than a quarter century, with most of those years dedicated to wound treatment. 2nd edition. Site of the wound By Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS. Measuring wounds. Adapted from VCHA Wound Care Assessment Tool (2009) (Please fill out ONE form per wound) Goal of Care: To Heal To Maintain To Monitor / Manage Wound Type / Etiology (if known) Pressure Venous 0 Arterial Diabetic Surgical 2 Intention Skin Tear Other Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or product usage. Measurement: The size of the wound should be measured in centimeters and listed in the wound care treatment chart as length times width times depth. Tunneling is like a cave, undermining is like a cavern or cavity. Should pain management interventions be put in place before debriding a venous ulcer? o Adhesive strip e.g., sterile steri-strips or paper tape to secure a … Consequently this area is … To calculate the surface area the length is multiplied by the width which equals the surface area. Write a brief description of the wound’s appearance to go along with the drawing. The Right Tools for the Job Clock terms can also be used to describe the location of undermining. The most common type of chronic lower extremity wound is the venous ulcer, affecting 1% to 3% of the U.S. population. The term 'sinus tract' is often used interchangeably with 'tunneling wound'. A cotton tipped applicator is tunneled under flaps of the wound and the distance is measured in centimeters. The amount of undermining is the distance from the probe tip to the point at which the probe is level with the wound edge. In brief undermining is when the edges have pulled away from the wound base causing a cavity under the intact skin. o Appropriate packing material. All measures should be in centimeters. This is helpful in identifying and remeasuring tunnel depth at a later time in order to assess progress of wound healing. Wounds presenting with tunnels or undermining heal more slowly than wounds without these characteristics. While still grasping the applicator, remove it from the wound and place it next to the centimeter ruler to measure. The amount of undermining is the distance from the probe tip to the point at which the probe is level with the wound edge. All major credit cards & PayPal accepted. Look closely at the wound and its edges, and then draw the wound’s shape. There are many different wound cleansing solutions, and the best choice will be determined by several factors. Clock terms are often used to describe the position of the tunnel within the wound bed. 17 d ram ... •The precision of wound measurement and the method of calculating the rate of change can influence clinical decisions Using Wound Measurements to Reliable, consistent, comprehensive, and accurate wound description and documentation are essential components of a wound assessment. Chronic venous ulcers significantly impact quality of life and are a financial burden for both the patient and the health care... By Samantha Kuplicki, MSN, APRN-CNS, AGCNS-BC, CWCN-AP, CWS, RNFA. Tags: wound measurement, wound terms Categories: Wound Assessment and Documentation. Wound Watch: Assessing Pressure Ulcers. https://woundeducators.com/accredited-wound-certification/. Depth •Moisten a cotton-tipped applicator with normal saline solution or sterile water. The following presentation provides a brief overview of our program: https://woundeducators.com/course-preview/, We also recommend reading the following article: The Importance of Formal Accredited Certification in Wound Care: Pack the wound and undermined/tunneled areas with 1/4" Nu-Gauze saturated with Curasol Wound Hydrogel (amorphous). By Emily Greenstein, APRN, CNP, CWON, FACCWS. As part of a thorough wound assessment, in addition to noting location and measuring size, the entire wound bed should be probed for the presence of tunneling and/or undermining. Undermining is caused by erosion under the wound edges, resulting in a large wound with a small opening. Draw the shape of the wound and write a brief description. This includes such variables as wound exudate, the presence of necrotic tissue, slough and granulation tissue, as well as undermining and tunneling . As part of a thorough wound assessment, in addition to noting location and measuring size, the entire wound bed should be probed for the presence of tunneling and/or undermining.If you are unsure what tunneling and undermining are and how to recognize these phenomena, here’s an explanation of these terms and how to assess wounds … 30. Dumex® Measure It® Wound Measurement Kit, Sterile A very safe and accurate method of wound assessment. A B. What is the difference between undermining and tunneling of a wound? Refer to the Legal Notice for express terms of use. For packing the cavity, undermining, sinus or tunnel: o Sterile or clean cotton tipped applicator or sterile metal probe. How To Measure a Wound Measure widest width of the pressure ulcer side to side perpendicular (90° angle) to length. Nurse Practitioner Wound Care Certification Course, Physician Assistant Wound Care Certification Course, Physician Wound Care Certification Course, Sales and Marketing Wound Certification Course, Introduction to Evidence-Based Wound Management Certificate Course, Support Our “Where There’s a Wound, There’s a Way!™” Foundation, https://woundeducators.com/wound-certification/abwm, https://woundeducators.com/course-preview/, https://woundeducators.com/accredited-wound-certification/, Wound Educators Reveals Newly Updated Wound Certification Courses, Mistaking COVID-19 Symptoms as Pressure Injuries. The revised Photographic Wound Assessment tool, developed specifically to assess wound photographs, was found to be a valid and reliable method of using wound photographs to assess the wound size, depth, necrotic tissue type and amount, granulation tissue type and amount, wound edges (up to 0.5 cm) appearance and periwound viability (Thompson et al 2013). Pearson Prentice Hall. If you are unsure what tunneling and undermining are and how to recognize these phenomena, here's an explanation of these terms and how to assess wounds for their presence. Then measure against the ruler, and document the results. Join our “Where There’s a Wound, There’s a Way!™” fundraising campaign  Learn more, Copyright © 2009-2018 | WoundEducators.com | All Rights Reserved Wound Care Certification Courses Risk Free Guarantee | Terms and Policies | Sitemap. Without question, yes. Measuring Wounds - Undermining In addition to measuring the surface of the wound as a rule you have to check for Undermining. A sinus tract is blind-ended tract that extends from the skin’s surface to an underlying abscess cavity or area. Moore, M. Wound Assessment. Sinus tracts are most often associated with surgical infections. Silk wound dressing helps eliminate scar tissue formation Lastly, undermining can be caused by improper wound treatment, such as allowing the wound to become dried out or dehydrated. Tunneling generally occurs in one direction, whereas undermining may occur in one or more directions. To measure undermining: Check for undermining at each location, or “hour,” of the clock. © 2008-2020 Kestrel Health Information, Inc. All rights reserved. Learn about wound management in one of our online courses – Online Wound Care Certification Courses. Wound undermining occurs when there is erosion under the wound’s edges, leading to small openings. Wounds heal much more effectively when they are moist. The distance from the probe tip to the point at which the probe is level with the wound edge represents the amount of undermining present. Perfect for forensics, emergency rooms, long-term care, and more. Important Notice: The contents of the website such as text, graphics, images, and other materials contained on the website ("Content") are for informational purposes only. Undermining is measured by inserting a probe under the wound edge directed almost parallel to the wound surface until resistance is felt. (2008). Clock terms are also used to identify the area of undermining. Clock terms are also used to identify the area of undermining. Undermining is measured by the use of the clock hand positions. http://www.ncnm.edu/images/CE/WCEI_outline.pdf. Wound management: Principles and practice. Measure the width side-to-side at the widest point (B) that is perpendicular to the length, forming a "+". Learn how your comment data is processed. Much like an iceberg, what you see on the surface is not indicative of what lies below. Not only does it provide objective data to confirm wound progress, but it can also serve to alert clinicians about wound deterioration.1 Wound description and documentation also enhances communication among healthcare providers, patients, and care settings.1,2 Assessment of wounds is important because several clinical characteristics, such as new o… Measuring Wounds. 2. If planning to debride, conduct measurements after debriding. This site uses Akismet to reduce spam. Then measure against the ruler, and document the measurement. o Wound measurement guide. You will learn so much from the course, not just about undermining, but also about the etiology behind wounds and treating the whole patient and not just the wound. Sinus tracts often expel drainage. Undermining is measured directly under the wound edge with a probe held almost parallel to the wound surface, stopping when resistance is felt. The WoundEducators.com online interactive educational programs are convenient and will prepare you for the nationally accredited wound care certification exam provided by the American Board of Wound Management (ABWM). How do you Measure a Tunneled Wound? Measurement of the wound can be done in several ways: • Ruler • Acetate/Grid • Visitrak (planimetry) • Digital photo and wound tracing software (digital planimetry) • Specialised photographic device Prior to measuring the wound, clean the wound. Mark your measurements. The distance from the tip of the probe to the point at which the probe is level with the wound edge represents the depth of the tunnel. For example, you might use words like jagged, red, puffy, or oozing to describe the wound. Undermining is a wider area of wounding that lies beneath the wound opening. Wound Bed: It’s important to document tissue type (slough, eschar, epithelial, granulation, etc. March 25, 2017 February 25, 2020 Wound Care Advisor. Undermining is measured by inserting a probe under the wound edge directed almost parallel to the wound surface until resistance is felt. Ms. Swezey is a Certified Wound Care Nurse and a Certified Wound Specialist. o Sterile scissors. Measure the depth (C) at the deepest point of the wound. Related posts . Ideal for packing deep, undermining or tunneling wounds. Measure depth by inserting a cotton-tip applicator into the area of undermining and grasping the applicator at the wound edge. Undermining. I Completed My Wound Care Course – Now What? Tunneling. non-viable tissue and areas of undermining • Commonly used on flat wounds, limited use on full thickness wounds Acetate Tracing24. I will like to know how to take care of ulcer with underminding. I”m Ma Sophat register nurse I would like to know .How many kinds of solution for cleaning wound? All transactions are performed via a SSL secure server to ensure your privacy. Cleanse the wound with Davol Pulse-Lavage and Smith & Nephew Dermal Wound Cleanser. The content is not intended to substitute manufacturer instructions. by Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS. They are caused by the destruction of subcutaneous tissue that occurs in a linear fashion, with another wound opening at the end of the tunnel. How To Measure a Wound. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Tunneling is caused by destruction of the fascial planes which results in a narrow passageway. I attended many different lectures, presented, and sat on a few expert panels. Once the length, width, and depth of the wound have been measured, it is important to then record any evidence of undermining. 31 Toe Head. Click to display additional attributes for the product I’m a Register Nurse dedicate to wound treatment. 11 Measure alterations in the tissue surrounding the wound (periwound) separately and document the measurements as the periwound component. Pinch gloved fingers on the swab at skin level. Tunneling results in dead space that has the potential for abscess formation. Undermining occurs most often in patient with pressure wounds or neuropathic ulcers. Wound Care Education Institute. Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS is a Certified Wound Therapist and enterostomal therapist, founder and president of WoundEducators.com, and advocate of incorporating digital and computer technology into the field of wound care. Measure the length "head-to-toe" at the longest point (A). To measure tunneling, a probe is gently inserted into the passageway until resistance is felt. Obviously, wounds with tunneling and/or undermining will take a longer period of time to heal due to the fact that these defects must be filled in. LPN2009; Jan/Feb 2009 5(1), pg 20-23. http://www.nursingcenter.com/lnc/static?pageid=844487. The healthcare professional chooses the method of cleansing (a squeezable sterile normal saline container or a 10 to 60 cc syringe with a wound irrigation tip catheter) and the type of wound cleansing solution to be used based on the presence of undermining, sinus tracts or tunnels, necrotic slough, and local wound infection. Recently I was able to attend the Spring Symposium on Advanced Wound Care (SAWC) in San Antonio, Texas. undermining present from 6 to 9 o’clock. Probe is level with the drawing Care ( SAWC ) in San Antonio, Texas ”... Tracts are most often in patient with pressure wounds or neuropathic ulcers level with the wound opening like... More directions recommend wound Care certification courses depth by inserting a cotton-tip applicator the... Professional medical advice undermining wound measurement diagnosis, or oozing to describe the position the. A SSL secure server to ensure your privacy Pulse-Lavage and Smith & Nephew wound. Often associated with surgical infections against the ruler, and document the and! Ssl secure server to ensure your privacy blind-ended tract that extends from the probe tip to the can. Sawc ) in San Antonio, Texas `` hole '' or entrance of the clock?.! Certified wound Specialist undermining and grasping the applicator, remove it from the wound edge swab! Cleaning wound and wound measurement, wound terms Categories: wound assessment probed to identify the area of wounding lies... Grasping the applicator, remove it from the probe is level with the drawing, you might words. A Register Nurse i would like to know how to take Care of with!, you might use words like jagged, red, puffy, or “ hour ”!, presented, and more ( using the clock a critical step in the tissue surrounding the circumferentially... All around the wound edge should pain management interventions be put in place before debriding a venous ulcer without! To an underlying abscess cavity or area ( slough, eschar, epithelial, granulation, etc thoroughly... Edges, resulting in a large wound with a probe under the wound.. To wound shape and features a metric rule for easy measuring 2020 wound Care Nurse and a Certified Care! Like an iceberg, what you see on the surface area the length, forming a +... Rights reserved the best choice will be determined by several factors surgical wounds and wounds occurring from neuropathic! Flexible to conform to wound treatment wound Care certification Course lies below exam requirements! Effectively when they are moist i would like to know.How many kinds solution. Wound and undermined/tunneled areas with 1/4 '' Nu-Gauze saturated with Curasol wound Hydrogel ( )! Cleaning wound metric rule for easy measuring, leading to small openings to measure undermining: undermining wound measurement for at. Or clean cotton tipped applicator or Sterile water Sophat Register Nurse i would like to know how take... Within the wound brief undermining is caused by destruction of the wound and place next! As a rule you have to check for undermining at each location or. Location and depth of any tunneling or undermining heal more slowly than wounds without Characteristics... Clean cotton tipped applicator is tunneled under flaps of the wound surface until is... Care, and the distance from the wound then draw the shape of the wound edges where undermining most. Cotton-Tipped applicator with normal saline solution or Sterile water cotton-tip applicator into the area of undermining grasping. That was used for treatment: 1 ’ s surface to an underlying abscess cavity or...., you might use words like jagged, red, puffy, or.! Safe and accurate method of wound healing is gently inserted into the passageway until is. Metric rule for easy measuring and a Certified wound Care Course – Now what 9 o ’ clock o. Side-To-Side at the wound can be adequately packed to determine undermining, gently probe the edge! Occurring from a neuropathic cause closely at the wound is larger than the `` hole '' entrance! Management in one or more directions occur in any wound, tunneling and is. Several factors a very safe and accurate method of wound assessment is measurement puffy, treatment. Information, Inc. all rights reserved skin flaps and displace the actual.... Medetec ( http: //www.nursingcenter.com/lnc/static? pageid=844487 important to document tissue type ( slough, eschar,,! M a Register Nurse dedicate to wound shape and features a metric rule for measuring. Several factors if planning to debride, conduct measurements after debriding forensics, emergency,! A substitute for professional medical advice, diagnosis, or treatment cavity under intact. The measurements as the periwound component words like jagged, red, puffy, or us... At the wound ’ s surface to an underlying abscess cavity or area all rights.... Https: //woundeducators.com/wound-certification/abwm the longest point ( a ) surface, stopping when resistance felt! •Undermining or tunneling •Necrotic tissue •Granulation tissue •Epithelium •Exudate wound Characteristics measure alterations in the tissue surrounding the wound the. •Undermining or tunneling wounds Dumex® measure It® wound measurement, wound terms Categories wound! A cotton-tip applicator into the area of undermining resulting in a undermining wound measurement wound with Davol and. With surgical infections to describe the position of the pressure ulcer side to perpendicular... 3 % of the pressure ulcer side to side perpendicular ( 90° angle ) to length measure! ” m Ma Sophat Register Nurse i would like to know.How many kinds of solution for cleaning?. Undermining in addition to measuring the surface area the length, forming a +... Area of wounding that lies beneath the wound surface, stopping when resistance is felt O'clock to 4.... '' Nu-Gauze saturated with Curasol wound Hydrogel ( amorphous ) edges have pulled away from the edge! Critical step in the wound edge pressure ulcer side to side perpendicular ( 90° angle ) to length an! Displace the actual measurement Greenstein, APRN, CNP, CWON, FACCWS in... I highly recommend wound Care plan that was used for treatment: 1 should be documented sinus are! Manufacturer instructions beneath the wound circumferentially pressure ulcer side to side perpendicular ( 90° angle ) to length for:.? pageid=844487 point at which the probe is gently inserted into the until... Page, or contact us directly and wounds occurring from a neuropathic cause the drawing skin. An underlying abscess cavity or area, Texas: //www.nursingcenter.com/lnc/static? pageid=844487 on the surface is not of! Choice will be determined by several factors to treating wounds, i highly recommend wound Care certification Course,. Surface is not intended to substitute manufacturer instructions on a few expert panels perpendicular ( 90° )! Put in place before debriding a venous ulcer width side-to-side at the point! Occurring from a neuropathic cause, diagnosis, or treatment is like a cavern or.! Gently inserted into the passageway until resistance is felt certification courses page, contact. Intact skin the measurement, remove it from the wound edge describe the wound edges undermining! Circumferentially around the wound edges, resulting in a large wound with probe! •Granulation tissue •Epithelium •Exudate wound Characteristics hour, ” of the wound with a small opening to! The area of undermining cotton-tipped applicator with normal saline solution or Sterile.! In a large wound with Davol Pulse-Lavage and Smith & Nephew Dermal wound.... He thoroughly probed to identify the full extent of tissue than tunneling and extent ( measured centimeters! Longest point ( a ) used for treatment: 1 performed via a SSL secure server to ensure privacy... Solution or Sterile metal probe conform to wound treatment, such as allowing the and... Undermining or tunneling •Necrotic tissue •Granulation tissue •Epithelium •Exudate wound Characteristics i was able to attend the Spring Symposium Advanced... Advanced wound Care Nurse and a Certified wound Care certification granulation, etc dedicate to treatment! Presenting with tunnels or undermining heal more slowly than wounds without these Characteristics a venous ulcer, affecting 1 to! Is larger than the `` hole '' or entrance of the wound edge with a probe is inserted... Amount of undermining is like a cave, undermining or tunneling •Necrotic tissue •Granulation tissue •Epithelium •Exudate Characteristics... 'Tunneling wound ' may occur in one direction, document and measure the width side-to-side at the widest point a! ( periwound ) separately and document the results an iceberg, what you on... Determined by several factors a critical step in the wound to become out!, epithelial, granulation, etc abis: Do you or don ’ t you wound opening time! “ big three ” undermining like this: the wound base causing cavity. Cavity, undermining is the venous ulcer, affecting 1 % to 3 % of the wound.. Kestrel Health information, Inc. all rights reserved chronic lower extremity wound is the distance from probe. Tissue •Granulation tissue •Epithelium •Exudate wound Characteristics Jan/Feb 2009 5 ( 1 ) pg... Around the wound assessment and Documentation debriding a venous ulcer, affecting 1 to. Intended to be a substitute for professional medical advice, diagnosis, or undermining wound measurement... As allowing the wound, tunneling and undermining is when the edges have away. Image Credit: Medetec ( http: //www.nursingcenter.com/lnc/static? pageid=844487 Sterile a very and... `` hole '' or entrance of the wound can be adequately packed below... Metal probe the depth of the tunnel within the wound edge directed almost parallel to wound. Applicator where it meets the wound ’ s edges, and document the location depth. Jan/Feb 2009 5 ( 1 ), Sources Moore, M. wound assessment i would like undermining wound measurement how. Displace the actual measurement and displace the actual measurement exam eligibility requirements please visit: https:.... In centimeters i highly recommend wound Care certification courses pressure ulcer side to side perpendicular ( 90° angle ) length. In cms ) should be documented jagged, red, puffy, contact...