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Reliability and Accuracy of Techniques for Surface Area Measurements of Wounds and Scars

Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, the Netherlands, Burn Center, Red Cross Hospital, Beverwijk, the Netherlands, Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center, Amsterdam, the Netherlands paul.van.zuijlen{at}wxs.nl

Adam P. Angeles, MD

Department of Surgery, Section of Plastic and Reconstructive Surgery, Temple University Hospital, Philadelphia, PA

Monique H. Suijker, MD

Sophia Kinderziekenhuis, Rotterdam, the Netherlands

Robert W. Kreis, MD, PhD

Burn Center, Red Cross Hospital, Beverwijk, the Netherlands, Department of Surgery, VU University Medical Centre, Amsterdam, the Netherlands

Esther Middelkoop, PhD

Burn Center, Red Cross Hospital, Beverwijk, the Netherlands, Dutch Burns Foundation, Beverwijk, the Netherlands

The applicability of simple methods to measure the size of pathological skin lesions for management and research has been poorly studied to date. The interobserver reliability and accuracy (validity) was established for planimetry by photography and planimetry by tracing on a transparent sheet in this study. Drawings of 25, 50, and 75 cm² were created on 3 locations with increasing curvature (back, thigh, and forearm) in 20 healthy volunteers. Three investigators evaluated the drawings by both planimetry techniques. Both techniques showed a good reliability (r 0.82, intraclass correlation) for 25 cm² areas. Planimetry by photography was more reliable than planimetry by tracings for the 50 -and 75-cm² areas and was more accurate than planimetry by tracing for all areas except for the area with the greatest curvature, the forearm. The study permits the conclusion that planimetry by photography is more suitable for surface area measurements than planimetry by tracing except for extremely curved body parts, where it is likely that effects of distortion supervene.

Key Words: chronic wounds • outcome • surface area • planimetry • photography • accuracy

The International Journal of Lower Extremity Wounds, Vol. 3, No. 1, 7-11 (2004)
DOI: 10.1177/1534734604263200


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