Measure the most excellent length, width, and depth of the wound in centimeters Examples of wound classification tools: NPUAP staging system for pressure injuries Payne-Martin classification system for skin tears CEAP (clinical, etiologic, anatomic, and pathophysiology) system for venous ulcers Tunneling or Undermining Tunneling occurs when a wound moves underneath the skin, making a tunnel. The tunneling depth can be measured by gently inserting a sterile, cotton-tipped applicator into the tunnel and noting the length from the wound base to the end of the tract (7)
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