Accurate and regular measurement of the wound is important to give an objective assessment of the effectiveness of the current management plan. The leg ulcer measurement tool (LUMT) is a validated tool that has been developed to quantify leg ulcer assessment and can be used to track change in wound status over time. Various methods have been used to document an ulcer of the lower extremity (Fig. 7.3). They can be broadly classified into the following:

Role of ulcer measurement tools is to see progress of wound healing, and these are instrumental in monitoring of wound healing after different modes of interventions. Only limited role of ulcer measurement tools is well defined in experimental studies of chronic ulcers.

Due to rapid, easy, and inexpensive assessment, Duplex ultrasound can be considered as a screening tool for detecting vascular pathology in chronic ulcers. Combination of ultrasound with Doppler detects the distribution and extent of vascular disease. It is regarded as the investigation of choice for the diagnosis of venous reflux, thrombosis, arterial obstruction, and aneurysms [13, 14]. Stenosis and occlusion can be clearly demonstrated and differentiated with adequate information about surface characteristics and plaque content to direct the treatment plan according to etiology and anatomical delineation of pathology of the vascular segment affected. In chronic cases or during follow-up, collateral pathways and flow dynamics are demonstrated leading to the identification of acute, chronic, or recurrent thrombosis. Duplex scan is an excellent tool to differentiate tumors, cysts, hematoma, clots, thrombus, and foreign body in vascular tree. Considering its excellent sensitivity and availability, it is integral in the diagnosis and follow-up with effect on treatment, progression of disease, or developments of new pathology. Duplex is superior in the detection of venous reflux with a sensitivity greater than 75 %, compared to approximately 40 % for descending venography. Neglen and Raju suggest that combining Duplex scanning with air plethysmography helps differentiate severe venous disease from mild venous disease [15].

Considering the surgical options in chronic ulcers, plethysmography is used to detect and quantify arterial and venous diseases [16, 17]. Several types of plethysmography have been evolved such as air, photo, and strain gauge. Depending on the device used, pressure and flow measurements, waveform patterns, volume changes, amount of reflux, degree of venous obstruction, and the efficiency of calf muscle pumps can be calculated. All these parameters are important as the severity of the disease can be demonstrated to determine the impact of ulceration. So, these are good tests to assess treatment and progression of the disease. Venous pressure data are important in determining the need for surgical bypass or valve replacement. Quantitative data on venous obstruction, calf muscle pump ejection fraction, and reflux are provided by air plethysmography, whereas venous pressure studies assess the physiological importance of anatomic obstruction because the collaterals may or may not provide adequate compensation for an obstructed pathway. Dual significance with both diagnostic and prognostic efficacies is associated with plethysmography, but its use is limited mostly to academic and research purpose.

In chronic ulcer, spiral CT angiography (CTA) is an accurate modality to assess the presence and extent of peripheral arterial disease (PAD). This investigation is done only if the active intervention is required to salvage the limb and improve the quality of life by reducing rate of limb loss and persistent pain. Modes of interventions are either endovascular, open surgery, or hybrid techniques. CT angiography has become popular due to rapid technical developments in terms of shorter acquisition times, thinner slices, higher spatial resolution, and improvement of multidetector computed tomographic scanners that enable the scanning of the whole vascular tree in a limited period with limited contrast [18]. CT venography (CTV) is also accurate to determine proximal venous obstruction, but as it is relatively static, one cannot evaluate reflux. CT can also detect aneurysms, AV fistulae, and any other pathologies like neoplasms and can determine the extent of disease and involvement of surrounding structures. Both CT arteriography and CT venography are considered as excellent tools for differential diagnosis to detect vascular lesion in chronic ulcers [19].