Early Wound Healing Score: a system to evaluate the early healing of periodontal soft tissue wounds

Abstract

Purpose: Numerous indices have been proposed to analyse wound healing in oral soft tissues, but each has specific shortcomings. A new method of analysis, the Early Wound Healing Score (EHS), was evaluated in the present study. The aim was to assess more accurately early healing by primary intention of surgical incisions in periodontal soft tissues.

Methods: Twenty-one patients were treated with different surgical procedures comprising 1 or 2 vertical releasing incisions as part of a surgical access flap. Twenty-four hours after surgery, early wound healing at the vertical releasing incisions was assessed using the EHS. This score assessed clinical signs of re-epithelialization (CSR), clinical signs of haemostasis (CSH), and clinical signs of inflammation (CSI). Since complete wound epithelialization was the main outcome, the CSR score was weighted to be 60% of the total final score. Accordingly, a score of 0, 3, or 6 points was possible for the assessment of CSR, whereas scores of 0, 1, or 2 points were possible for CSH and CSI. Higher values indicated better healing. Accordingly, the score for ideal early wound healing was 10.

Results: Thirty vertical releasing incisions were assessed in 21 patients. At 24 hours after incision, 16 vertical releasing incisions (53.33%) received the maximum score of CSR, while 6 cases (20%) received an EHS of 10. None of the cases received 0 points.

Conclusion: The EHS system may be a useful tool for assessing early wound healing in periodontal soft tissue by primary intention after surgery.

Keywords: Gingiva; Periodontal diseases; Soft tissue injuries; Symptom assessment; Wound healing.

Figure 1. Graphic representations of CSR. (A) Merged incision margins (6 points for CSR). (B) Incision margins in contact (3 points for CSR). (C) Visible distance between incision margins (0 points for CSR).

CSR: clinical signs of re-epithelialization.

Figure 2. Graphic representations of the CSH and CSI. (A) Presence of fibrin on the incision margins (1 point for CSH). (B) Bleeding at the incision margins (0 points for CSH). (C) Redness involving <50% of the incision length (1 point for CSI). (D) Redness involving >50% of the incision length and/or pronounced swelling (0 points for CSI).

CSH: clinical signs of haemostasis, CSI: clinical signs of inflammation.

Figure 3. Clinical photographs of vertical releasing incisions exhibiting decreasing values of the EHS. (A) The value of EHS is 10 (merged incision margins: 6; absence of fibrin on the incision margins: 2; absence of redness along the incision length: 2). (B) The value of EHS is 9 (merged incision margins: 6; absence of fibrin on the incision margins: 2; redness involving <50% of the incision length: 1). (C) The value of EHS is 5 (incision margins in contact: 3; bleeding at the incision margins: 0; absence of redness along the incision length: 2). (D) The value of EHS is 5 (incision margins in contact: 3; presence of fibrin on the incision margins: 1; redness involving <50% of the incision length: 1). (E) The value of EHS is 3 (incision margins in contact: 3; bleeding at the incision margins: 0; redness involving >50% of the incision length and/or pronounced swelling: 0). (F) The value of EHS is 1 (visible distance between incision margins: 0; bleeding at the incision margins: 0; redness involving <50% of the incision length: 1).

EHS: Early Wound Healing Score.