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Phelan HA, Holmes JH, Hickerson WL, Cockerell CJ, Shupp JW, Carter JE. Iterative refinement of a histologic algorithm for burn depth categorization based on 798 consecutive burn wound biopsies. Burns 2024; 50:23-30. [PMID: 38040616 DOI: 10.1016/j.burns.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 07/11/2023] [Accepted: 10/09/2023] [Indexed: 12/03/2023]
Abstract
INTRODUCTION Our group previously reported a burn biopsy algorithm (BBA-V1) for categorizing burn wound depth. Here, we sought to promulgate a newer, simpler version of the BBA (BBA-V2). METHODS Burn wounds undergoing excision underwent 4 mm biopsies procured every 25 cm2. Serial still photos were obtained at enrollment and at excision intraoperatively. Burn wounds assessed as likely to heal by 21 days were imaged within 72 h of injury and at 21 days. A sample of 798 burn wound biopsies were classified by both BBAV1 and BBAV2 algorithms. For nonoperative burn wounds, the proportion of healing versus nonhealing pixels at 21 days after injury were compared. RESULTS The 798 biopsies were classified by BBAV1 as 24% SPT, 47% DPT, 28% FT and by BBAV2 as 3% SPT, 67% DPT, and 30% FT (p < 0.0001). Overall, the proportion of biopsies whose wound reclassification changed from a nonoperative to operative pathway was 21% (95% CI: 18-24%). Nonoperative wounds judged at injury as being SPT contained 12.8 million pixels. Repeat 21-day imaging revealed 11.3 million healed pixels (accuracy = 89.6% (95% CI: 89.59-89.62)). CONCLUSIONS BBA-V2 was associated with a significantly higher concordance with visual assessment for burn wounds clinically judged as deep partial and full thickness.
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Supervised machine learning for automatic classification of in vivo scald and contact burn injuries using the terahertz Portable Handheld Spectral Reflection (PHASR) Scanner. Sci Rep 2022; 12:5096. [PMID: 35332207 PMCID: PMC8948290 DOI: 10.1038/s41598-022-08940-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 03/04/2022] [Indexed: 12/21/2022] Open
Abstract
We present an automatic classification strategy for early and accurate assessment of burn injuries using terahertz (THz) time-domain spectroscopic imaging. Burn injuries of different severity grades, representing superficial partial-thickness (SPT), deep partial-thickness (DPT), and full-thickness (FT) wounds, were created by a standardized porcine scald model. THz spectroscopic imaging was performed using our new fiber-coupled Portable HAndheld Spectral Reflection Scanner, incorporating a telecentric beam steering configuration and an f-\documentclass[12pt]{minimal}
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\begin{document}$$\theta$$\end{document}θ scanning lens. ASynchronous Optical Sampling in a dual-fiber-laser THz spectrometer with 100 MHz repetition rate enabled high-speed spectroscopic measurements. Given twenty-four different samples composed of ten scald and ten contact burns and four healthy samples, supervised machine learning algorithms using THz-TDS spectra achieved areas under the receiver operating characteristic curves of 0.88, 0.93, and 0.93 when differentiating between SPT, DPT, and FT burns, respectively, as determined by independent histological assessments. These results show the potential utility of our new broadband THz PHASR Scanner for early and accurate triage of burn injuries.
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3
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Yang R, Wang Z, Li J, Pi X, Wang X, Xu Y, Shi Y, Zhou S. Identification and Verification of Five Potential Biomarkers Related to Skin and Thermal Injury Using Weighted Gene Co-Expression Network Analysis. Front Genet 2022; 12:781589. [PMID: 35047008 PMCID: PMC8762241 DOI: 10.3389/fgene.2021.781589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/22/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Burn injury is a life-threatening disease that does not have ideal biomarkers. Therefore, this study first applied weighted gene co-expression network analysis (WGCNA) and differentially expressed gene (DEG) screening methods to identify pivotal genes and diagnostic biomarkers associated with the skin burn process. Methods: After obtaining transcriptomic datasets of burn patient skin and normal skin from Gene Expression Omnibus (GEO) and performing differential analysis and functional enrichment, WGCNA was used to identify hub gene modules associated with burn skin processes in the burn patient peripheral blood sample dataset and determine the correlation between modules and clinical features. Enrichment analysis was performed to identify the functions and pathways of key module genes. Differential analysis, WGCNA, protein-protein interaction analysis, and enrichment analysis were utilized to screen for hub genes. Hub genes were validated in two other GEO datasets, tested by immunohistochemistry for hub gene expression in burn patients, and receiver operating characteristic curve analysis was performed. Finally, we constructed the specific drug activity, transcription factors, and microRNA regulatory network of the five hub genes. Results: A total of 1,373 DEGs in GSE8056 were obtained, and the top 5 upregulated genes were S100A12, CXCL8, CXCL5, MMP3, and MMP1, whereas the top 5 downregulated genes were SCGB1D2, SCGB2A2, DCD, TSPAN8, and KRT25. DEGs were significantly enriched in the immunity, epidermal development, and skin development processes. In WGCNA, the yellow module was identified as the most closely associated module with tissue damage during the burn process, and the five hub genes (ANXA3, MCEMP1, MMP9, S100A12, and TCN1) were identified as the key genes for burn injury status, which consistently showed high expression in burn patient blood samples in the GSE37069 and GSE13902 datasets. Furthermore, we verified using immunohistochemistry that these five novel hub genes were also significantly elevated in burn patient skin. In addition, MCEMP1, MMP9, and S100A12 showed perfect diagnostic performance in the receiver operating characteristic analysis. Conclusion: In conclusion, we analyzed the changes in genetic processes in the skin during burns and used them to identify five potential novel diagnostic markers in blood samples from burn patients, which are important for burn patient diagnosis. In particular, MCEMP1, MMP9, and S100A12 are three key blood biomarkers that can be used to identify skin damage in burn patients.
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Affiliation(s)
- Ronghua Yang
- Department of Burn Surgery and Skin Regeneration, The First People's Hospital of Foshan, Foshan, China
| | - Zhengguang Wang
- Department of Orthopedics, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Jiehua Li
- Department of Dermatology, The First People's Hospital of Foshan, Foshan, China
| | - Xiaobing Pi
- Department of Dermatology, The First People's Hospital of Foshan, Foshan, China
| | - Xiaoxiang Wang
- Department of Burn Surgery and Skin Regeneration, The First People's Hospital of Foshan, Foshan, China
| | - Yang Xu
- Department of Molecular Pharmacology, School of Medicine, Nankai University, Tianjin, China
| | - Yan Shi
- Department of Wound Repair and Institute of Wound Repair, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen, China.,The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Sitong Zhou
- Department of Dermatology, The First People's Hospital of Foshan, Foshan, China
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4
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Sandora N, Fitria NA, Kusuma TR, Winarno GA, Tanjunga SF, Wardhana A. Amnion bilayer for dressing and graft replacement for delayed grafting of full-thickness burns; A study in a rat model. PLoS One 2022; 17:e0262007. [PMID: 35061768 PMCID: PMC8782387 DOI: 10.1371/journal.pone.0262007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 12/15/2021] [Indexed: 11/19/2022] Open
Abstract
Burn is a common case in developing countries, with over half of fire-related deaths reported in Southeast Asia and full-thickness burns as a high mortality risk. Human amnion has been used as a wound dressing for centuries. In this study, a decellularised amnion overlaid with fibrin, “amnion bilayer (AB),” was used as a dressing immediately after burn and as a graft to replace the scar in Sprague-Dawley rats subjected to full-thickness burn model. The aim was to observe whether amnion bilayer can reduce damages in third-grade burn when skin replacement is deemed impossible. The burn was induced using an electrical solder, heated for 5 mins, and contacted on the rat’s bare skin for 20 s. AB was applied as a (i) dressing immediately after induction and graft after eschar removal. Two groups (n = 6) were compared: AB and Sofra-Tulle ®, the National Hospital of Indonesia (NHI) protocol. Sections were stained with hematoxylin and eosin and Masson trichrome stains. Immunohistochemistry labelling was used to indicate scars (α-smooth muscle actin [α-SMA] and collagen-1) and angiogenesis (von Willebrand factor). Also, the macrophages inflammatory protein-3α (MIP-3α) indicates an early inflammatory process. The post dressing of the AB group demonstrated hair follicle remains and adipose tissue development. The NHI group appeared with a denatured matrix. Complete healing was seen in the AB group after 28 days with skin appendages similar to normal, while the NHI group showed no appendages in the centre of the actively inflamed area. The α-SMA was found in both groups. Collagen-1 was highly expressed in the NHI group, which led to a scar. Angiogenesis was found more in the AB group. The AB group had shown the capacity to accelerate complete healing and recover skin appendages better than the current protocol.
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Affiliation(s)
- Normalina Sandora
- Faculty of Medicine, Universitas Riau, Pekanbaru, Indonesia
- Indonesian Medical Education and Research Institute (IMERI), Jakarta, Indonesia
| | - Nur Amalina Fitria
- Indonesian Medical Education and Research Institute (IMERI), Jakarta, Indonesia
| | - Tyas Rahmah Kusuma
- Indonesian Medical Education and Research Institute (IMERI), Jakarta, Indonesia
| | - Gammaditya Adhibarata Winarno
- Burn Unit, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
- Department of Surgery, Plastic and Reconstructive Surgery Division, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Sanjaya Faisal Tanjunga
- Burn Unit, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
- Department of Surgery, Plastic and Reconstructive Surgery Division, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Aditya Wardhana
- Burn Unit, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
- Department of Surgery, Plastic and Reconstructive Surgery Division, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- * E-mail:
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5
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Sasaki J, Matsushima A, Ikeda H, Inoue Y, Katahira J, Kishibe M, Kimura C, Sato Y, Takuma K, Tanaka K, Hayashi M, Matsumura H, Yasuda H, Yoshimura Y, Aoki H, Ishizaki Y, Isono N, Ueda T, Umezawa K, Osuka A, Ogura T, Kaita Y, Kawai K, Kawamoto K, Kimura M, Kubo T, Kurihara T, Kurokawa M, Kobayashi S, Saitoh D, Shichinohe R, Shibusawa T, Suzuki Y, Soejima K, Hashimoto I, Fujiwara O, Matsuura H, Miida K, Miyazaki M, Murao N, Morikawa W, Yamada S. Japanese Society for Burn Injuries (JSBI) Clinical Practice Guidelines for Management of Burn Care (3rd Edition). Acute Med Surg 2022; 9:e739. [PMID: 35493773 PMCID: PMC9045063 DOI: 10.1002/ams2.739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/29/2022] [Accepted: 02/03/2022] [Indexed: 01/28/2023] Open
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6
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Claes KEY, Hoeksema H, Vyncke T, Verbelen J, De Coninck P, De Decker I, Monstrey S. Evidence Based Burn Depth Assessment Using Laser-Based Technologies: Where Do We Stand? J Burn Care Res 2021; 42:513-525. [PMID: 33128377 DOI: 10.1093/jbcr/iraa195] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Early clinical assessment of burn depth and associated healing potential (HP) remains extremely challenging, even for experienced surgeons. Inaccurate diagnosis often leads to prolonged healing times and unnecessary surgical procedures, resulting in incremental costs, and unfavorable outcomes. Laser Doppler imaging (LDI) is currently the most objective and accurate diagnostic tool to measure blood flow and its associated HP, the main predictor for a patient's long-term functional and aesthetic outcome. A systematic review was performed on non-invasive, laser-based methods for burn depth assessment using skin microcirculation measurements to determine time to healing: Laser Doppler flowmetry (LDF), LDI and laser speckle contrast imaging (LSCI). Important drawbacks of single point LDF measurements are direct contact with numerous small points on the wound bed and the need to carry out serial measurements over several days. LDI is a fast, "non-contact," single measurement tool allowing to scan large burned areas with a 96% accuracy. LDI reduces the number of surgeries, improves the functional and aesthetic outcome and is cost-effective. There is only limited evidence for the use of LSCI in burn depth assessment. LSCI still needs technical improvements and scientific validation, before it can be approved for reliable burn assessment. LDI has proven to be invaluable in determining the optimal treatment of a burn patient. For unclear reasons, LDI is still not routinely used in burn centers worldwide. Additional research is required to identify potential "barriers" for universal implementation of this evidence-based burn depth assessment tool.
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Affiliation(s)
- Karel E Y Claes
- Burn Center, Ghent University Hospital, Ghent, Belgium.,Department of Plastic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Henk Hoeksema
- Burn Center, Ghent University Hospital, Ghent, Belgium.,Department of Plastic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Tom Vyncke
- Department of Plastic Surgery, Ghent University Hospital, Ghent, Belgium
| | | | | | | | - Stan Monstrey
- Burn Center, Ghent University Hospital, Ghent, Belgium.,Department of Plastic Surgery, Ghent University Hospital, Ghent, Belgium
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7
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Liu K, Chen Z, Zhou W, Xing D. Towards quantitative assessment of burn based on photoacoustic and optical coherence tomography. JOURNAL OF BIOPHOTONICS 2020; 13:e202000126. [PMID: 32609427 DOI: 10.1002/jbio.202000126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/18/2020] [Accepted: 06/22/2020] [Indexed: 06/11/2023]
Abstract
Accurate and timely assessment of the severity of burn is essential for the treatment of burns. Currently, although most first-degree and third-degree burns are easily diagnosed through visual inspection or auxiliary diagnostic methods, the second-degree burn is still difficult to distinguish due to the ambiguity boundaries of second-degree with first-degree and third-degree burns. In this study, we proposed a non-invasive technique by combing photoacoustic imaging (PAI) and optical coherence tomography (OCT) to multi-parameter quantitatively assess the burns. The feasibility and capacity of the dual-mode PAT/OCT for assessing the burns was first testified by tissue-mimicking phantom and burn wounds in mouse pinna in vivo. The further experiments conducted on the back of rats showed that the changes in skin scattering structure, vascular morphology and blood flow provided by the dual-mode PAI/OCT system can determine distinct boundaries and depth of the burns. The experimental results prove that combined PAI/OCT as a novel method can be used to assess the severity of burn, which has the potential to diagnose the burns in clinic.
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Affiliation(s)
- Kang Liu
- MOE Key Laboratory of Laser Life Science & Institute of Laser Life Science, College of Biophotonics, South China Normal University, Guangzhou, 510631, China
- Guangdong Provincial Key Laboratory of Laser Life Science, College of Biophotonics, South China Normal University, Guangzhou, 510631, China
| | - Zhongjiang Chen
- MOE Key Laboratory of Laser Life Science & Institute of Laser Life Science, College of Biophotonics, South China Normal University, Guangzhou, 510631, China
- Guangdong Provincial Key Laboratory of Laser Life Science, College of Biophotonics, South China Normal University, Guangzhou, 510631, China
| | - Wangting Zhou
- MOE Key Laboratory of Laser Life Science & Institute of Laser Life Science, College of Biophotonics, South China Normal University, Guangzhou, 510631, China
- Guangdong Provincial Key Laboratory of Laser Life Science, College of Biophotonics, South China Normal University, Guangzhou, 510631, China
| | - Da Xing
- MOE Key Laboratory of Laser Life Science & Institute of Laser Life Science, College of Biophotonics, South China Normal University, Guangzhou, 510631, China
- Guangdong Provincial Key Laboratory of Laser Life Science, College of Biophotonics, South China Normal University, Guangzhou, 510631, China
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8
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Ye H, Rahul, Kruger U, Wang T, Shi S, Norfleet J, De S. Raman spectroscopy accurately classifies burn severity in an ex vivo model. Burns 2020; 47:812-820. [PMID: 32928613 DOI: 10.1016/j.burns.2020.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 07/31/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
Accurate classification of burn severities is of vital importance for proper burn treatments. A recent article reported that using the combination of Raman spectroscopy and optical coherence tomography (OCT) classifies different degrees of burns with an overall accuracy of 85% [1]. In this study, we demonstrate the feasibility of using Raman spectroscopy alone to classify burn severities on ex vivo porcine skin tissues. To create different levels of burns, four burn conditions were designed: (i) 200°F for 10s, (ii) 200°F for 30s, (iii) 450°F for 10s and (iv) 450°F for 30s. Raman spectra from 500-2000cm-1 were collected from samples of the four burn conditions as well as the unburnt condition. Classifications were performed using kernel support vector machine (KSVM) with features extracted from the spectra by principal component analysis (PCA), and partial least-square (PLS). Both techniques yielded an average accuracy of approximately 92%, which was independently evaluated by leave-one-out cross-validation (LOOCV). By comparison, PCA+KSVM provides higher accuracy in classifying severe burns, while PLS performs better in classifying mild burns. Variable importance in the projection (VIP) scores from the PLS models reveal that proteins and lipids, amide III, and amino acids are important indicators in separating unburnt or mild burns (200°F), while amide I has a more pronounced impact in separating severe burns (450°F).
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Affiliation(s)
- Hanglin Ye
- Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute, Troy, NY, USA.
| | - Rahul
- Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Uwe Kruger
- Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Tianmeng Wang
- The Department of Chemical and Biological Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Sufei Shi
- The Department of Chemical and Biological Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Jack Norfleet
- U.S. Army Futures Command, Combat Capabilities Development Command Soldier Center STTC, Orlando, FL, USA
| | - Suvranu De
- Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute, Troy, NY, USA.
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9
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Yoshino Y, Hashimoto A, Ikegami R, Irisawa R, Kanoh H, Sakurai E, Nakanishi T, Maekawa T, Tachibana T, Amano M, Hayashi M, Ishii T, Iwata Y, Kawakami T, Sarayama Y, Hasegawa M, Matsuo K, Ihn H, Omoto Y, Madokoro N, Isei T, Otsuka M, Kukino R, Shintani Y, Hirosaki K, Motegi S, Kawaguchi M, Asai J, Isogai Z, Kato H, Kono T, Tanioka M, Fujita H, Yatsushiro H, Sakai K, Asano Y, Ito T, Kadono T, Koga M, Tanizaki H, Fujimoto M, Yamasaki O, Doi N, Abe M, Inoue Y, Kaneko S, Kodera M, Tsujita J, Fujiwara H, Le Pavoux A. Wound, pressure ulcer and burn guidelines – 6: Guidelines for the management of burns, second edition. J Dermatol 2020; 47:1207-1235. [DOI: 10.1111/1346-8138.15335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 03/05/2020] [Indexed: 01/28/2023]
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10
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Abstract
This article presents a real-time approach for classification of burn depth based on B-mode ultrasound imaging. A grey-level co-occurrence matrix (GLCM) computed from the ultrasound images of the tissue is employed to construct the textural feature set and the classification is performed using nonlinear support vector machine and kernel Fisher discriminant analysis. A leave-one-out cross-validation is used for the independent assessment of the classifiers. The model is tested for pair-wise binary classification of four burn conditions in ex vivo porcine skin tissue: (i) 200 °F for 10 s, (ii) 200 °F for 30 s, (iii) 450 °F for 10 s, and (iv) 450 °F for 30 s. The average classification accuracy for pairwise separation is 99% with just over 30 samples in each burn group and the average multiclass classification accuracy is 93%. The results highlight that the ultrasound imaging-based burn classification approach in conjunction with the GLCM texture features provide an accurate assessment of altered tissue characteristics with relatively moderate sample sizes, which is often the case with experimental and clinical datasets. The proposed method is shown to have the potential to assist with the real-time clinical assessment of burn degrees, particularly for discriminating between superficial and deep second degree burns, which is challenging in clinical practice.
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11
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Wang R, Zhao J, Zhang Z, Cao C, Zhang Y, Mao Y. Diagnostic Accuracy of Laser Doppler Imaging for the Assessment of Burn Depth: A Meta-analysis and Systematic Review. J Burn Care Res 2019; 41:619-625. [PMID: 31872859 DOI: 10.1093/jbcr/irz203] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Abstract
An overall assessment of the diagnostic value of laser Doppler imaging (LDI) to assess burn depth in patients is presented based on relevant studies. Both eligible research and relevant articles were identified through specific index searches of Embase, Cochrane, and PubMed databases. The latest study included was published in March 2019 and all eligible publications reported on cohort or cross-sectional research. All articles were tested for heterogeneity by using a suitable effect model to calculate amalgamative values of sensitivity, specificity, and the diagnostic odds ratio (DOR). Analyses of summary receiver operating characteristic (SROC) are given for burn depth values. After rigorous screening, 14 studies with a total cohort of 1,818 patients were chosen for the meta-analysis to explore the validity of LDI diagnosis to assess the depth of burns. The burn depth overall sensitivity for LDI was 91% (95% CI: 86–95%) and global specificity was 96% (95% CI: 92–98%). The overall positive likelihood ratio of LDI was 20.35 (95% CI: 10.71–38.69) and the overall negative likelihood ratio was 0.09 (95% CI: 0.05–0.15). The overall DOR was 152.93 (95% CI: 69.44–336.81) of LDI. The acreage under the SROC was not low for LDI (AUC = 0.98; 95% CI: 0.96–0.99). In conclusion, the present analysis reviewed the literature and meta-analysis of studies to validate LDI for the diagnosis of burn depth. The results indicated that LDI has a high accuracy for this diagnostic function.
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Affiliation(s)
- Ru Wang
- Department of Burns and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Juan Zhao
- Department of Burns and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhenyu Zhang
- Department of Burns and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chang Cao
- Department of Burns and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yange Zhang
- Department of Burns and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yu Mao
- Department of Pediatric, Sichuan Provincial People’s Hospital, Chengdu, China
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12
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Boccara D, Bekara F, Soussi S, Legrand M, Chaouat M, Mimoun M, Serror K. Ongoing Development and Evaluation of a Method of Telemedicine: Burn Care Management With a Smartphone. J Burn Care Res 2019; 39:580-584. [PMID: 29789857 DOI: 10.1093/jbcr/irx022] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
In cases involving small burns in patients without a comorbidity or associated pathology, a referral from a surgeon is necessary and sometimes it cannot be ascertained when the patient is not brought in by a specialized team. The purpose of this retrospective study was to evaluate the quality of our method for performing telemedicine. This retrospective study included the 323 patients who were initially treated using the telemedicine system implemented between 2011 and 2016. This procedure only involved patients burned over a small portion of their body's surface area (ie, ≤15%) who were between 15 and 75 years of age and who did not have a major comorbidity. The purpose of the procedure was to evaluate the need for surgery. The initial diagnosis regarding the need for a surgical procedure was accurate in 94.4% (305/323) of the cases. Eleven patients (3.4%) were transferred unnecessarily as they ultimately did not require surgery, and seven patients (2.2%) were ultimately transferred even though the need for surgery was not initially established at the time that the pictures were viewed. No initial errors in the photographic evaluation caused a worsening in the life-threatening, functional, or aesthetic prognoses. We have recently opted to use telemedicine for initial patient management. In 94.4% of cases, the opinion that was provided was accurate. Only 3.2% of the patients for whom outpatient treatment was recommended ultimately underwent surgery without subsequently experiencing the slightest injury due to any delay in therapy. Although it will never replace clinical examination, these results have encouraged us to develop telemedicine based on digital photography.
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Affiliation(s)
- David Boccara
- Plastic, Reconstructive, Cosmetic, and Burn Surgery Unit, Hôpital Saint Louis, Paris, France
| | - Farid Bekara
- Plastic, Reconstructive, Cosmetic, and Burn Surgery Unit, Hôpital Saint Louis, Paris, France
| | - Sabri Soussi
- Plastic, Reconstructive, Cosmetic, and Burn Surgery Unit, Hôpital Saint Louis, Paris, France
| | - Matthieu Legrand
- Plastic, Reconstructive, Cosmetic, and Burn Surgery Unit, Hôpital Saint Louis, Paris, France
| | - Marc Chaouat
- Plastic, Reconstructive, Cosmetic, and Burn Surgery Unit, Hôpital Saint Louis, Paris, France
| | - Maurice Mimoun
- Plastic, Reconstructive, Cosmetic, and Burn Surgery Unit, Hôpital Saint Louis, Paris, France
| | - Kevin Serror
- Plastic, Reconstructive, Cosmetic, and Burn Surgery Unit, Hôpital Saint Louis, Paris, France
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13
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Deng H, Li-Tsang CW. Measurement of vascularity in the scar: A systematic review. Burns 2019; 45:1253-1265. [DOI: 10.1016/j.burns.2018.10.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 06/28/2018] [Accepted: 10/31/2018] [Indexed: 01/24/2023]
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14
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Interobserver reliability of laser speckle contrast imaging in the assessment of burns. Burns 2019; 45:1325-1335. [DOI: 10.1016/j.burns.2019.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 12/13/2018] [Accepted: 01/30/2019] [Indexed: 11/30/2022]
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15
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Heeman W, Steenbergen W, van Dam GM, Boerma EC. Clinical applications of laser speckle contrast imaging: a review. JOURNAL OF BIOMEDICAL OPTICS 2019; 24:1-11. [PMID: 31385481 PMCID: PMC6983474 DOI: 10.1117/1.jbo.24.8.080901] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/02/2019] [Indexed: 05/02/2023]
Abstract
When a biological tissue is illuminated with coherent light, an interference pattern will be formed at the detector, the so-called speckle pattern. Laser speckle contrast imaging (LSCI) is a technique based on the dynamic change in this backscattered light as a result of interaction with red blood cells. It can be used to visualize perfusion in various tissues and, even though this technique has been extensively described in the literature, the actual clinical implementation lags behind. We provide an overview of LSCI as a tool to image tissue perfusion. We present a brief introduction to the theory, review clinical studies from various medical fields, and discuss current limitations impeding clinical acceptance.
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Affiliation(s)
- Wido Heeman
- University of Groningen, Faculty Campus Fryslân, Leeuwarden, The Netherlands
- University Medical Centre Groningen, Department of Surgery, Optical Molecular Imaging Groningen, Groningen, The Netherlands
- LIMIS Development BV, Leeuwarden, The Netherlands
| | - Wiendelt Steenbergen
- University of Twente, Techmed Center, Faculty of Science and Technology, Biomedical Photonic Imaging Group, Enschede, The Netherlands
| | - Gooitzen M. van Dam
- University Medical Centre Groningen, Department of Surgery, Optical Molecular Imaging Groningen, Groningen, The Netherlands
| | - E. Christiaan Boerma
- Medical Centre Leeuwarden, Department of Intensive Care, Leeuwarden, The Netherlands
- Address all correspondence to E. Christiaan Boerma, E-mail:
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A systematic review on the quality of measurement techniques for the assessment of burn wound depth or healing potential. Burns 2018; 45:261-281. [PMID: 29941159 DOI: 10.1016/j.burns.2018.05.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 03/28/2018] [Accepted: 05/17/2018] [Indexed: 11/22/2022]
Abstract
PURPOSE Reliable and valid assessment of burn wound depth or healing potential is essential to treatment decision-making, to provide a prognosis, and to compare studies evaluating different treatment modalities. The aim of this review was to critically appraise, compare and summarize the quality of relevant measurement properties of techniques that aim to assess burn wound depth or healing potential. METHODS A systematic literature search was performed using PubMed, EMBASE and Cochrane Library. Two reviewers independently evaluated the methodological quality of included articles using an adapted version of the Consensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. A synthesis of evidence was performed to rate the measurement properties for each technique and to draw an overall conclusion on quality of the techniques. RESULTS Thirty-six articles were included, evaluating various techniques, classified as (1) laser Doppler techniques; (2) thermography or thermal imaging; (3) other measurement techniques. Strong evidence was found for adequate construct validity of laser Doppler imaging (LDI). Moderate evidence was found for adequate construct validity of thermography, videomicroscopy, and spatial frequency domain imaging (SFDI). Only two studies reported on the measurement property reliability. Furthermore, considerable variation was observed among comparator instruments. CONCLUSIONS Considering the evidence available, it appears that LDI is currently the most favorable technique; thereby assessing burn wound healing potential. Additional research is needed into thermography, videomicroscopy, and SFDI to evaluate their full potential. Future studies should focus on reliability and measurement error, and provide a precise description of which construct is aimed to measure.
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17
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Lertsakdadet B, Yang BY, Dunn CE, Ponticorvo A, Crouzet C, Bernal N, Durkin AJ, Choi B. Correcting for motion artifact in handheld laser speckle images. JOURNAL OF BIOMEDICAL OPTICS 2018; 23:1-7. [PMID: 29546735 PMCID: PMC5852319 DOI: 10.1117/1.jbo.23.3.036006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 02/21/2018] [Indexed: 05/03/2023]
Abstract
Laser speckle imaging (LSI) is a wide-field optical technique that enables superficial blood flow quantification. LSI is normally performed in a mounted configuration to decrease the likelihood of motion artifact. However, mounted LSI systems are cumbersome and difficult to transport quickly in a clinical setting for which portability is essential in providing bedside patient care. To address this issue, we created a handheld LSI device using scientific grade components. To account for motion artifact of the LSI device used in a handheld setup, we incorporated a fiducial marker (FM) into our imaging protocol and determined the difference between highest and lowest speckle contrast values for the FM within each data set (Kbest and Kworst). The difference between Kbest and Kworst in mounted and handheld setups was 8% and 52%, respectively, thereby reinforcing the need for motion artifact quantification. When using a threshold FM speckle contrast value (KFM) to identify a subset of images with an acceptable level of motion artifact, mounted and handheld LSI measurements of speckle contrast of a flow region (KFLOW) in in vitro flow phantom experiments differed by 8%. Without the use of the FM, mounted and handheld KFLOW values differed by 20%. To further validate our handheld LSI device, we compared mounted and handheld data from an in vivo porcine burn model of superficial and full thickness burns. The speckle contrast within the burn region (KBURN) of the mounted and handheld LSI data differed by <4 % when accounting for motion artifact using the FM, which is less than the speckle contrast difference between superficial and full thickness burns. Collectively, our results suggest the potential of handheld LSI with an FM as a suitable alternative to mounted LSI, especially in challenging clinical settings with space limitations such as the intensive care unit.
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Affiliation(s)
- Ben Lertsakdadet
- Beckman Laser Institute and Medical Clinic, Irvine, California, United States
- University of California, Department of Biomedical Engineering, Irvine, California, United States
- University of California, Irvine, California, United States
| | - Bruce Y. Yang
- Beckman Laser Institute and Medical Clinic, Irvine, California, United States
- University of California, Irvine, California, United States
| | - Cody E. Dunn
- Beckman Laser Institute and Medical Clinic, Irvine, California, United States
- University of California, Department of Biomedical Engineering, Irvine, California, United States
- University of California, Irvine, California, United States
| | - Adrien Ponticorvo
- Beckman Laser Institute and Medical Clinic, Irvine, California, United States
- University of California, Irvine, California, United States
| | - Christian Crouzet
- Beckman Laser Institute and Medical Clinic, Irvine, California, United States
- University of California, Department of Biomedical Engineering, Irvine, California, United States
- University of California, Irvine, California, United States
| | - Nicole Bernal
- University of California, Irvine, California, United States
- University of California, Department of Surgery, Irvine, California, United States
| | - Anthony J. Durkin
- Beckman Laser Institute and Medical Clinic, Irvine, California, United States
- University of California, Department of Biomedical Engineering, Irvine, California, United States
- University of California, Irvine, California, United States
| | - Bernard Choi
- Beckman Laser Institute and Medical Clinic, Irvine, California, United States
- University of California, Department of Biomedical Engineering, Irvine, California, United States
- University of California, Irvine, California, United States
- Address all correspondence to: Bernard Choi, E-mail:
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18
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Jan SN, Khan FA, Bashir MM, Nasir M, Ansari HH, Shami HB, Nazir U, Hanif A, Sohail M. Comparison of Laser Doppler Imaging (LDI) and clinical assessment in differentiating between superficial and deep partial thickness burn wounds. Burns 2018; 44:405-413. [DOI: 10.1016/j.burns.2017.08.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/25/2017] [Accepted: 08/28/2017] [Indexed: 11/25/2022]
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Abstract
Visual diagnosis of second-degree burns has proven inadequate for determining the appropriate treatment regimen. Although multiple noninvasive imaging techniques have shown promise for providing information about burn wound severity, the ideal technology to aid burn wound excision would provide real-time readouts. Herein, the authors examine a high-resolution infrared (IR) camera (thermography) and a multiprobe adapter system (MPAS-6; transepidermal evaporative water loss, colorimetry) to assess their usefulness in predicting burn severity. Contact burn wounds of increasing severity were created in a porcine model. Wounds were assessed for 4 days with an IR camera and MPAS-6. In addition, each day, the burn wounds were biopsied for histological analysis to determine burn depth for correlation with noninvasive measures. Surface temperatures decreased with increasing burn severity, which was associated with increasing transepidermal evaporative water loss. Melanin content correlated with the depth of collagen coagulation and was bimodal, with superficial and full-thickness burns having higher values than deep partial thickness wounds. Erythema content was highest in superficial burns and negatively correlated with necrosis (high-mobility group box protein 1 expression). Importantly, surface temperature taken on every single day after injury was predictive of all histologically determined measurements of burn depth (ie, collagen coagulation, apoptosis, necrosis, vascular occlusion). The results indicate that IR imaging and skin quality probes can be used to support the diagnosis of burn severity. Most importantly, IR measurements gave insight into both the zone of coagulation and the zone of stasis on every postburn day studied.
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20
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Accuracy of laser speckle contrast imaging in the assessment of pediatric scald wounds. Burns 2018; 44:90-98. [DOI: 10.1016/j.burns.2017.06.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 05/08/2017] [Accepted: 06/24/2017] [Indexed: 11/19/2022]
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21
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Ye H, De S. Thermal injury of skin and subcutaneous tissues: A review of experimental approaches and numerical models. Burns 2017; 43:909-932. [PMID: 27931765 PMCID: PMC5459687 DOI: 10.1016/j.burns.2016.11.014] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 10/20/2016] [Accepted: 11/16/2016] [Indexed: 01/16/2023]
Abstract
Thermal injury to skin and subcutaneous tissue is common in both civilian and combat scenarios. Understanding the change in tissue morphologies and properties and the underlying mechanisms of thermal injury are of vital importance to clinical determination of the degree of burn and treatment approach. This review aims at summarizing the research involving experimental and numerical studies of skin and subcutaneous tissue subjected to thermal injury. The review consists of two parts. The first part deals with experimental studies including burn protocols and prevailing imaging approaches. The second part deals with existing numerical models for burns of tissue and related computational simulations. Based on this review, we conclude that though there is literature contributing to the knowledge of the pathology and pathogenesis of tissue burn, there is scant quantitative information regarding changes in tissue properties including mechanical, thermal, electrical and optical properties as a result of burns that are linked to altered tissue morphology.
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Affiliation(s)
- Hanglin Ye
- Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Suvranu De
- Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute, Troy, NY, USA.
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22
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Diagnostic and Prognostic Utility of Non-Invasive Multimodal Imaging in Chronic Wound Monitoring: a Systematic Review. J Med Syst 2017; 41:46. [PMID: 28194684 DOI: 10.1007/s10916-016-0679-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 12/12/2016] [Indexed: 01/09/2023]
Abstract
Monitoring chronic wound [CW] healing is a challenging issue for clinicians across the world. Moreover, the health and cost burden of CW are escalating at a disturbing rate due to a global rise in population of elderly and diabetic cases. The conventional approach includes visual contour, sketches, or more rarely tracings. However, such conventional techniques bring forth infection, pain, allergies. Furthermore, these methods are subjective as well as time-consuming. As such, nowadays, non-touching and non-invasive CW monitoring system based on imaging techniques are gaining importance. They not only reduce patients' discomfort but also provide rapid wound diagnosis and prognosis. This review provides a survey of different types of CW characteristics, their healing mechanism and the multimodal non-invasive imaging methods that have been used for their diagnosis and prognosis. Current clinical practices as well as personal health systems [m-health and e-health] for CW monitoring have been discussed.
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23
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Diagnostic accuracy of laser Doppler imaging in burn depth assessment: Systematic review and meta-analysis. Burns 2016; 42:1369-1376. [DOI: 10.1016/j.burns.2016.03.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 02/18/2016] [Accepted: 03/17/2016] [Indexed: 12/31/2022]
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24
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Thatcher JE, Squiers JJ, Kanick SC, King DR, Lu Y, Wang Y, Mohan R, Sellke EW, DiMaio JM. Imaging Techniques for Clinical Burn Assessment with a Focus on Multispectral Imaging. Adv Wound Care (New Rochelle) 2016; 5:360-378. [PMID: 27602255 DOI: 10.1089/wound.2015.0684] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 03/16/2016] [Indexed: 11/13/2022] Open
Abstract
Significance: Burn assessments, including extent and severity, are some of the most critical diagnoses in burn care, and many recently developed imaging techniques may have the potential to improve the accuracy of these evaluations. Recent Advances: Optical devices, telemedicine, and high-frequency ultrasound are among the highlights in recent burn imaging advancements. We present another promising technology, multispectral imaging (MSI), which also has the potential to impact current medical practice in burn care, among a variety of other specialties. Critical Issues: At this time, it is still a matter of debate as to why there is no consensus on the use of technology to assist burn assessments in the United States. Fortunately, the availability of techniques does not appear to be a limitation. However, the selection of appropriate imaging technology to augment the provision of burn care can be difficult for clinicians to navigate. There are many technologies available, but a comprehensive review summarizing the tissue characteristics measured by each technology in light of aiding clinicians in selecting the proper device is missing. This would be especially valuable for the nonburn specialists who encounter burn injuries. Future Directions: The questions of when burn assessment devices are useful to the burn team, how the various imaging devices work, and where the various burn imaging technologies fit into the spectrum of burn care will continue to be addressed. Technologies that can image a large surface area quickly, such as thermography or laser speckle imaging, may be suitable for initial burn assessment and triage. In the setting of presurgical planning, ultrasound or optical microscopy techniques, including optical coherence tomography, may prove useful. MSI, which actually has origins in burn care, may ultimately meet a high number of requirements for burn assessment in routine clinical use.
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Affiliation(s)
| | - John J. Squiers
- Spectral MD, Inc., Dallas, Texas
- Baylor Research Institute, Baylor Scott & White Health, Dallas, Texas
| | | | | | - Yang Lu
- Spectral MD, Inc., Dallas, Texas
| | | | | | | | - J. Michael DiMaio
- Spectral MD, Inc., Dallas, Texas
- Baylor Research Institute, Baylor Scott & White Health, Dallas, Texas
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25
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Kumar R, Griffin M, Adigbli G, Kalavrezos N, Butler PEM. Lipotransfer for radiation-induced skin fibrosis. Br J Surg 2016; 103:950-61. [PMID: 27169866 DOI: 10.1002/bjs.10180] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 12/21/2015] [Accepted: 03/02/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND Radiation-induced fibrosis (RIF) is a late complication of radiotherapy that results in progressive functional and cosmetic impairment. Autologous fat has emerged as an option for soft tissue reconstruction. There are also sporadic reports suggesting regression of fibrosis following regional lipotransfer. This systematic review aimed to identify cellular mechanisms driving RIF, and the potential role of lipotransfer in attenuating these processes. METHODS PubMed, OVID and Google Scholar databases were searched to identify all original articles regarding lipotransfer for RIF. All articles describing irradiated fibroblast or myofibroblast behaviour were included. Data elucidating the mechanisms of RIF, role of lipotransfer in RIF and methods to quantify fibrosis were extracted. RESULTS Ninety-eight studies met the inclusion criteria. A single, definitive model of RIF is yet to be established, but four cellular mechanisms were identified through in vitro studies. Twenty-one studies identified connective tissue growth factor and transforming growth factor β1 cytokines as drivers of fibrotic cascades. Hypoxia was demonstrated to propagate fibrogenesis in three studies. Oxidative stress from the release of reactive oxygen species and free radicals was also linked to RIF in 11 studies. Purified autologous fat grafts contain cellular and non-cellular properties that potentially interact with these processes. Six methods for quantifying fibrotic changes were evaluated including durometry, ultrasound shear wave elastography, thermography, dark field imaging, and laser Doppler and laser speckle flowmetry. CONCLUSION Understanding how lipotransfer causes regression of RIF remains unclear; there are a number of new hypotheses for future research.
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Affiliation(s)
- R Kumar
- Division of Surgery and Interventional Science, Royal Free Campus, London, UK.,Charles Wolfson Centre for Reconstructive Surgery, Royal Free Hospital, London, UK
| | - M Griffin
- Division of Surgery and Interventional Science, Royal Free Campus, London, UK.,Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK.,Charles Wolfson Centre for Reconstructive Surgery, Royal Free Hospital, London, UK
| | - G Adigbli
- Division of Surgery and Interventional Science, Royal Free Campus, London, UK.,Charles Wolfson Centre for Reconstructive Surgery, Royal Free Hospital, London, UK
| | - N Kalavrezos
- Head and Neck Unit, Macmillan Cancer Centre, University College London Hospital, London, UK.,Charles Wolfson Centre for Reconstructive Surgery, Royal Free Hospital, London, UK
| | - P E M Butler
- Division of Surgery and Interventional Science, Royal Free Campus, London, UK.,Head and Neck Unit, Macmillan Cancer Centre, University College London Hospital, London, UK.,Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK.,Charles Wolfson Centre for Reconstructive Surgery, Royal Free Hospital, London, UK
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26
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Yoshino Y, Ohtsuka M, Kawaguchi M, Sakai K, Hashimoto A, Hayashi M, Madokoro N, Asano Y, Abe M, Ishii T, Isei T, Ito T, Inoue Y, Imafuku S, Irisawa R, Ohtsuka M, Ogawa F, Kadono T, Kawakami T, Kukino R, Kono T, Kodera M, Takahara M, Tanioka M, Nakanishi T, Nakamura Y, Hasegawa M, Fujimoto M, Fujiwara H, Maekawa T, Matsuo K, Yamasaki O, Le Pavoux A, Tachibana T, Ihn H. The wound/burn guidelines - 6: Guidelines for the management of burns. J Dermatol 2016; 43:989-1010. [PMID: 26971391 DOI: 10.1111/1346-8138.13288] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 12/04/2015] [Indexed: 12/16/2022]
Abstract
Burns are a common type of skin injury encountered at all levels of medical facilities from private clinics to core hospitals. Minor burns heal by topical treatment alone, but moderate to severe burns require systemic management, and skin grafting is often necessary also for topical treatment. Inappropriate initial treatment or delay of initial treatment may exert adverse effects on the subsequent treatment and course. Therefore, accurate evaluation of the severity and initiation of appropriate treatment are necessary. The Guidelines for the Management of Burn Injuries were issued in March 2009 from the Japanese Society for Burn Injuries as guidelines concerning burns, but they were focused on the treatment for extensive and severe burns in the acute period. Therefore, we prepared guidelines intended to support the appropriate diagnosis and initial treatment for patients with burns that are commonly encountered including minor as well as moderate and severe cases. Because of this intention of the present guidelines, there is no recommendation of individual surgical procedures.
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Affiliation(s)
- Yuichiro Yoshino
- Department of Dermatology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Mikio Ohtsuka
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
| | - Masakazu Kawaguchi
- Department of Dermatology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Keisuke Sakai
- Intensive Care Unit, Kumamoto University Hospital, Kumamoto, Japan
| | - Akira Hashimoto
- Department of Dermatology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Masahiro Hayashi
- Department of Dermatology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Naoki Madokoro
- Department of Dermatology, Mazda Hospital, Hiroshima, Japan
| | - Yoshihide Asano
- Department of Dermatology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Masatoshi Abe
- Department of Dermatology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Takayuki Ishii
- Department of Dermatology, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Taiki Isei
- Department of Dermatology, Kansai Medical University, Osaka, Japan
| | - Takaaki Ito
- Department of Dermatology, Hyogo College of Medicine, Hyogo, Japan
| | - Yuji Inoue
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Shinichi Imafuku
- Department of Dermatology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Ryokichi Irisawa
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - Masaki Ohtsuka
- Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Fumihide Ogawa
- Department of Dermatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takafumi Kadono
- Department of Dermatology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Tamihiro Kawakami
- Department of Dermatology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Ryuichi Kukino
- Department of Dermatology, NTT Medical Center, Tokyo, Japan
| | - Takeshi Kono
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
| | - Masanari Kodera
- Department of Dermatology, Japan Community Health Care Organization Chukyo Hospital, Aichi, Japan
| | - Masakazu Takahara
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Miki Tanioka
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Nakanishi
- Department of Dermatology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | | | - Minoru Hasegawa
- Department of Dermatology, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Manabu Fujimoto
- Department of Dermatology, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Hiroshi Fujiwara
- Department of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takeo Maekawa
- Department of Dermatology, Jichi Medical University, Tochigi, Japan
| | - Koma Matsuo
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
| | - Osamu Yamasaki
- Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | | | - Takao Tachibana
- Department of Dermatology, Osaka Red Cross Hospital, Osaka, Japan
| | - Hironobu Ihn
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
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27
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Goertz O, Over H, von der Lohe L, Lauer H, Ring A, Daigeler A, Lehnhardt M, Kolbenschlag J. Prednisolone but not selenium and rtPA reduces edema and improves angiogenesis after burn in mice. Burns 2016; 42:375-83. [DOI: 10.1016/j.burns.2015.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 07/06/2015] [Accepted: 08/07/2015] [Indexed: 10/22/2022]
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28
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Hyperspectral Imaging for Burn Depth Assessment in an Animal Model. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 3:e591. [PMID: 26894016 PMCID: PMC4727700 DOI: 10.1097/gox.0000000000000558] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 10/09/2015] [Indexed: 11/26/2022]
Abstract
UNLABELLED Differentiating between superficial and deep-dermal (DD) burns remains challenging. Superficial-dermal burns heal with conservative treatment; DD burns often require excision and skin grafting. Decision of surgical treatment is often delayed until burn depth is definitively identified. This study's aim is to assess the ability of hyperspectral imaging (HSI) to differentiate burn depth. METHODS Thermal injury of graded severity was generated on the dorsum of hairless mice with a heated brass rod. Perfusion and oxygenation parameters of injured skin were measured with HSI, a noninvasive method of diffuse reflectance spectroscopy, at 2 minutes, 1, 24, 48 and 72 hours after wounding. Burn depth was measured histologically in 12 mice from each burn group (n = 72) at 72 hours. RESULTS Three levels of burn depth were verified histologically: intermediate-dermal (ID), DD, and full-thickness. At 24 hours post injury, total hemoglobin (tHb) increased by 67% and 16% in ID and DD burns, respectively. In contrast, tHb decreased to 36% of its original levels in full-thickness burns. Differences in deoxygenated and tHb among all groups were significant (P < 0.001) at 24 hours post injury. CONCLUSIONS HSI was able to differentiate among 3 discrete levels of burn injury. This is likely because of its correlation with skin perfusion: superficial burn injury causes an inflammatory response and increased perfusion to the burn site, whereas deeper burns destroy the dermal microvasculature and a decrease in perfusion follows. This study supports further investigation of HSI in early burn depth assessment.
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29
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Dermoscopic insight into skin microcirculation – Burn depth assessment. Burns 2015; 41:1708-1716. [DOI: 10.1016/j.burns.2015.08.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 08/21/2015] [Accepted: 08/26/2015] [Indexed: 11/24/2022]
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30
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Burmeister DM, Ponticorvo A, Yang B, Becerra SC, Choi B, Durkin AJ, Christy RJ. Utility of spatial frequency domain imaging (SFDI) and laser speckle imaging (LSI) to non-invasively diagnose burn depth in a porcine model. Burns 2015; 41:1242-52. [PMID: 26138371 DOI: 10.1016/j.burns.2015.03.001] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 02/26/2015] [Accepted: 03/02/2015] [Indexed: 01/26/2023]
Abstract
Surgical intervention of second degree burns is often delayed because of the difficulty in visual diagnosis, which increases the risk of scarring and infection. Non-invasive metrics have shown promise in accurately assessing burn depth. Here, we examine the use of spatial frequency domain imaging (SFDI) and laser speckle imaging (LSI) for predicting burn depth. Contact burn wounds of increasing severity were created on the dorsum of a Yorkshire pig, and wounds were imaged with SFDI/LSI starting immediately after-burn and then daily for the next 4 days. In addition, on each day the burn wounds were biopsied for histological analysis of burn depth, defined by collagen coagulation, apoptosis, and adnexal/vascular necrosis. Histological results show that collagen coagulation progressed from day 0 to day 1, and then stabilized. Results of burn wound imaging using non-invasive techniques were able to produce metrics that correlate to different predictors of burn depth. Collagen coagulation and apoptosis correlated with SFDI scattering coefficient parameter [Formula: see text] and adnexal/vascular necrosis on the day of burn correlated with blood flow determined by LSI. Therefore, incorporation of SFDI scattering coefficient and blood flow determined by LSI may provide an algorithm for accurate assessment of the severity of burn wounds in real time.
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Affiliation(s)
- David M Burmeister
- United States Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, TX 78234, USA
| | - Adrien Ponticorvo
- Beckman Laser Institute and Medical Clinic, University of California Irvine, 1002 Health Sciences Road East, Irvine, CA 92617, USA
| | - Bruce Yang
- Beckman Laser Institute and Medical Clinic, University of California Irvine, 1002 Health Sciences Road East, Irvine, CA 92617, USA
| | - Sandra C Becerra
- United States Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, TX 78234, USA
| | - Bernard Choi
- Beckman Laser Institute and Medical Clinic, University of California Irvine, 1002 Health Sciences Road East, Irvine, CA 92617, USA; Biomedical Engineering Department, University of California Irvine, 3120 Natural Sciences II, Irvine, CA 92697, USA
| | - Anthony J Durkin
- Biomedical Engineering Department, University of California Irvine, 3120 Natural Sciences II, Irvine, CA 92697, USA
| | - Robert J Christy
- United States Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, TX 78234, USA.
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Crouzet C, Nguyen JQ, Ponticorvo A, Bernal NP, Durkin AJ, Choi B. Acute discrimination between superficial-partial and deep-partial thickness burns in a preclinical model with laser speckle imaging. Burns 2015; 41:1058-63. [PMID: 25814299 DOI: 10.1016/j.burns.2014.11.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 10/24/2014] [Accepted: 11/25/2014] [Indexed: 11/26/2022]
Abstract
A critical need exists for a robust method that enables early discrimination between superficial-partial and deep-partial thickness burn wounds. In this study, we report on the use of laser speckle imaging (LSI), a simple, non-invasive, optical imaging modality, to measure acute blood flow dynamics in a preclinical burn model. We used a heated brass comb to induce burns of varying severity to nine rats and collected raw speckle reflectance images over the course of three hours after burn. We induced a total of 12 superficial-partial and 18 deep-partial thickness burn wounds. At 3h after burn we observed a 28% and 44% decrease in measured blood flow for superficial-partial and deep-partial thickness burns, respectively, and that these reductions were significantly different (p=0.00007). This preliminary data suggests the potential role of LSI in the clinical management of burn wounds.
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Affiliation(s)
- Christian Crouzet
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, CA 92612, United States; Department of Biomedical Engineering, University of California, Irvine, CA 92697, United States
| | - John Quan Nguyen
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, CA 92612, United States
| | - Adrien Ponticorvo
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, CA 92612, United States
| | - Nicole P Bernal
- Department of Surgery, University of California, Irvine, CA 92868, United States
| | - Anthony J Durkin
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, CA 92612, United States; Department of Surgery, University of California, Irvine, CA 92868, United States
| | - Bernard Choi
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, CA 92612, United States; Department of Biomedical Engineering, University of California, Irvine, CA 92697, United States; Department of Surgery, University of California, Irvine, CA 92868, United States; Edwards Lifesciences Center for Advanced Cardiovascular Technology, University of California, Irvine, CA 92697, United States.
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Paul DW, Ghassemi P, Ramella-Roman JC, Prindeze NJ, Moffatt LT, Alkhalil A, Shupp JW. Noninvasive imaging technologies for cutaneous wound assessment: A review. Wound Repair Regen 2015; 23:149-62. [PMID: 25832563 DOI: 10.1111/wrr.12262] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 01/22/2015] [Indexed: 02/02/2023]
Abstract
The ability to phenotype wounds for the purposes of assessing severity, healing potential and treatment is an important function of evidence-based medicine. A variety of optical technologies are currently in development for noninvasive wound assessment. To varying extents, these optical technologies have the potential to supplement traditional clinical wound evaluation and research, by providing detailed information regarding skin components imperceptible to visual inspection. These assessments are achieved through quantitative optical analysis of tissue characteristics including blood flow, collagen remodeling, hemoglobin content, inflammation, temperature, vascular structure, and water content. Technologies that have, to this date, been applied to wound assessment include: near infrared imaging, thermal imaging, optical coherence tomography, orthogonal polarization spectral imaging, fluorescence imaging, laser Doppler imaging, microscopy, spatial frequency domain imaging, photoacoustic detection, and spectral/hyperspectral imaging. We present a review of the technologies in use or development for these purposes with three aims: (1) providing basic explanations of imaging technology concepts, (2) reviewing the wound imaging literature, and (3) providing insight into areas for further application and exploration. Noninvasive imaging is a promising advancement in wound assessment and all technologies require further validation.
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Affiliation(s)
- Dereck W Paul
- The Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC
| | - Pejhman Ghassemi
- Department of Electrical Engineering and Computer Science, The Catholic University of America, Washington, DC
| | - Jessica C Ramella-Roman
- Department of Biomedical Engineering and Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Nicholas J Prindeze
- The Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC
| | - Lauren T Moffatt
- The Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC
| | - Abdulnaser Alkhalil
- The Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC
| | - Jeffrey W Shupp
- The Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC
- Department of Surgery, The Burn Center, MedStar Washington Hospital Center, Washington, DC
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Ponticorvo A, Burmeister DM, Yang B, Choi B, Christy RJ, Durkin AJ. Quantitative assessment of graded burn wounds in a porcine model using spatial frequency domain imaging (SFDI) and laser speckle imaging (LSI). BIOMEDICAL OPTICS EXPRESS 2014; 5:3467-81. [PMID: 25360365 PMCID: PMC4206317 DOI: 10.1364/boe.5.003467] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 08/28/2014] [Indexed: 05/02/2023]
Abstract
Accurate and timely assessment of burn wound severity is a critical component of wound management and has implications related to course of treatment. While most superficial burns and full thickness burns are easily diagnosed through visual inspection, burns that fall between these extremes are challenging to classify based on clinical appearance. Because of this, appropriate burn management may be delayed, increasing the risk of scarring and infection. Here we present an investigation that employs spatial frequency domain imaging (SFDI) and laser speckle imaging (LSI) as non-invasive technologies to characterize in-vivo burn severity. We used SFDI and LSI to investigate controlled burn wounds of graded severity in a Yorkshire pig model. Burn wounds were imaged starting at one hour after the initial injury and daily at approximately 24, 48 and 72 hours post burn. Biopsies were taken on each day in order to correlate the imaging data to the extent of burn damage as indicated via histological analysis. Changes in reduced scattering coefficient and blood flow could be used to categorize burn severity as soon as one hour after the burn injury. The results of this study suggest that SFDI and LSI information have the potential to provide useful metrics for quantifying the extent and severity of burn injuries.
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Affiliation(s)
- Adrien Ponticorvo
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, 1002 Health Sciences Road East, Irvine, CA 92617, USA
- co-first authors
| | - David M. Burmeister
- United States Army Institute of Surgical Research, 3698 Chambers Pass, Fort Sam Houston, TX, 78234, USA
- co-first authors
| | - Bruce Yang
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, 1002 Health Sciences Road East, Irvine, CA 92617, USA
| | - Bernard Choi
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, 1002 Health Sciences Road East, Irvine, CA 92617, USA
- Department of Biomedical Engineering, University of California, Irvine, 3120 Natural Sciences II, Irvine, CA 92697, USA
| | - Robert J. Christy
- United States Army Institute of Surgical Research, 3698 Chambers Pass, Fort Sam Houston, TX, 78234, USA
| | - Anthony J. Durkin
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, 1002 Health Sciences Road East, Irvine, CA 92617, USA
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A systematic review of the evolution of laser Doppler techniques in burn depth assessment. PLASTIC SURGERY INTERNATIONAL 2014; 2014:621792. [PMID: 25180087 PMCID: PMC4142313 DOI: 10.1155/2014/621792] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 06/19/2014] [Indexed: 12/25/2022]
Abstract
Aims. The introduction of laser Doppler (LD) techniques to assess burn depth has revolutionized the treatment of burns of indeterminate depth. This paper will systematically review studies related to these two techniques and trace their evolution. At the same time we hope to highlight current controversies and areas where further research is necessary with regard to LD imaging (LDI) techniques. Methods. A systematic search for relevant literature was carried out on PubMed, Medline, EMBASE, and Google Scholar. Key search terms included the following: “Laser Doppler imaging,” “laser Doppler flow,” and “burn depth.” Results. A total of 53 studies were identified. Twenty-six studies which met the inclusion/exclusion criteria were included in the review. Conclusions. The numerous advantages of LDI over those of LD flowmetry have resulted in the former technique superseding the latter one. Despite the presence of alternative burn depth assessment techniques, LDI remains the most favoured. Various newer LDI machines with increasingly sophisticated methods of assessing burn depth have been introduced throughout the years. However, factors such as cost effectiveness, scanning of topographically inconsistent areas of the body, and skewing of results due to tattoos, peripheral vascular disease, and anaemia continue to be sighted as obstacles to LDI which require further research.
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Laser Doppler imaging as a tool in the burn wound treatment protocol. Wideochir Inne Tech Maloinwazyjne 2014; 9:24-30. [PMID: 24729806 PMCID: PMC3983546 DOI: 10.5114/wiitm.2014.40273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Revised: 05/20/2013] [Accepted: 08/10/2013] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The main treatment of burns is early excision of injured tissues. AIM TO COMPARE TWO DIFFERENT METHODS OF EXAMINATION OF BURNED PATIENTS: clinical burn depth examination (CDE) and laser Doppler imaging (LDI). MATERIAL AND METHODS A prospective randomized study of 57 burn patients treated in 2009-2011 was carried out. The burned patients were randomized into a CDE group and an LDI group. The CDE and LDI scan were performed 72 h after injury, with the second and third CDE and LDI scan on the 7(th) and 14(th) day after the burn. Age, sex, length of inpatient stay, cost of burn treatment, burn depth, cause and localization of the burns were analyzed between the two groups. RESULTS Fifty-seven patients were treated during 2 years. Thirty-two patients were in the CDE group and 25 patients were in the LDI group. Most of the patients were male (45 male vs. 12 female, p < 0.001). The age was similar between the males and the females (female: 46.4 ±16.9 years vs. male: 46.3 ±12.5 years; p = 0.11). The mean length of stay in hospital was significantly higher in the CDE group (47 ±34.4 day vs. 25 ±10.8 day; p = 0.005). The mean cost of treatment of burned patients was significantly higher in the CDE group. CONCLUSIONS The length of stay and cost of treatment of burn patients depends upon early diagnosis of the deep burns and well-timed surgical treatment of burn wounds.
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Lau YS, Brooks P. Innovative Use of Povidone-Iodine to Guide Burn Wound Debridement and Predict the Success of Biobrane as a Definitive Treatment for Burns. Adv Skin Wound Care 2014; 27:111-3. [DOI: 10.1097/01.asw.0000442875.94332.fd] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pape S, Baker R, Wilson D, Hoeksema H, Jeng J, Spence R, Monstrey S. Burn wound healing time assessed by laser Doppler imaging (LDI). Part 1: Derivation of a dedicated colour code for image interpretation. Burns 2012; 38:187-94. [DOI: 10.1016/j.burns.2010.11.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Revised: 10/29/2010] [Accepted: 11/06/2010] [Indexed: 10/15/2022]
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Erba P, Espinoza D, Koch N, Christen T, Serov A, Raffoul W. FluxEXPLORER: a new high-speed laser Doppler imaging system for the assessment of burn injuries. Skin Res Technol 2012; 18:456-61. [PMID: 22332947 DOI: 10.1111/j.1600-0846.2011.00593.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND Deep burn assessment made by clinical evaluation has an accuracy varying between 60% and 80% and will determine if a burn injury will need tangential excision and skin grafting or if it will be able to heal spontaneously. Laser Doppler Imaging (LDI) techniques allow an improved burn depth assessment but their use is limited by the time-consuming image acquisition which may take up to 6 min per image. METHODS To evaluate the effectiveness and reliability of a newly developed full-field LDI technology, 15 consecutive patients presenting with intermediate depth burns were assessed both clinically and by FluxExplorer LDI technology. Comparison between the two methods of assessment was carried out. RESULTS Image acquisition was done within 6 s. FluxEXPLORER LDI technology achieved a significantly improved accuracy of burn depth assessment compared to the clinical judgement performed by board certified plastic and reconstructive surgeons (P < 0.05, 93% of correctly assessed burns injuries vs. 80% for clinical assessment). CONCLUSION Technological improvements of LDI technology leading to a decreased image acquisition time and reliable burn depth assessment allow the routine use of such devices in the acute setting of burn care without interfering with the patient's treatment. Rapid and reliable LDI technology may assist clinicians in burn depth assessment and may limit the morbidity of burn patients through a minimization of the area of surgical debridement. Future technological improvements allowing the miniaturization of the device will further ease its clinical application.
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Affiliation(s)
- Paolo Erba
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
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40
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Early depth assessment of local burns by videomicroscopy: a novel proposed classification. Burns 2012; 38:371-7. [PMID: 22284389 DOI: 10.1016/j.burns.2011.08.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2011] [Revised: 08/04/2011] [Accepted: 08/29/2011] [Indexed: 11/22/2022]
Abstract
PURPOSE Videomicroscopy is very useful for burn depth assessment in an early phase; however, there is no practical classification that includes complicated anatomic, pathologic, and morphologic findings of burn wounds. The aim of this study was to propose a novel classification to assess burn depth in its early phase easily and reliably by videomicroscopy. METHODS Forty-four patients with 56 intermediate-depth burn wounds were included. Burn depth was divided into each grade according to our proposed classification, which is composed of five categories based on dermal capillary integrity patterns. The intrarater and interrater reliabilities of the assessment by the second and third authors were evaluated by Cohen's unweighted κ-value. RESULTS The results of the measurements according to the proposed classification showed an accuracy of 92.9%, sensitivity of 81.8%, and specificity of 100.0%. The intrarater reliability of the second and third authors showed substantial agreement (κ=0.719 and 0.729, respectively). The interrater reliability of the sum of each observer's variable also showed substantial agreement (κ=0.636). CONCLUSION This pattern analysis system is easy to use even for inexperienced personnel, and is reliable with high accuracy and specificity. Intrarater and interrater statistics also support its reliability and reproducibility.
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41
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Peeters W, Anthonissen M, Deliaert A, Van der Hulst R, Van den Kerckhove E. A comparison between laser-doppler imaging and colorimetry in the assessment of scarring: "a pilot study". Skin Res Technol 2011; 18:188-91. [PMID: 22092605 DOI: 10.1111/j.1600-0846.2011.00552.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND This cross-sectional pilot-study investigated the reproducibility of the LDI (Moor-LDI-B2; Moor Instruments) and the chromameter (Minolta chromameter CR-300) when used in scar assessment. METHODS Twenty-seven scars in 14 subjects were included between January and June 2003. One observer performed two times both measurements with 10 min apart. The intra-observer agreement is quantified by means of the intra-class correlations (ICC) and the standard errors of measurement (SEM) for both the LDI and the chromameter. RESULTS Ignoring one outlier, the ICC of the LDI = 0.856 and the SEM = 34.56. The chromameter shows a better reproducibility with an ICC of 0.93 and a SEM of 0.79. CONCLUSION This pilot-study with a limited number of measurements shows a moderate reproducibility of the LDI compared to the chromameter measurements, in the assessment of respectively flux and redness in scars.
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Affiliation(s)
- Wouter Peeters
- Department of Plastic Surgery, Academic Hospital Maastricht, Maastricht, The Netherlands.
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Goertz O, Ring A, Buschhaus B, Hirsch T, Daigeler A, Steinstraesser L, Steinau HU, Langer S. Influence of anti-inflammatory and vasoactive drugs on microcirculation and angiogenesis after burn in mice. Burns 2011; 37:656-64. [DOI: 10.1016/j.burns.2011.01.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Revised: 12/31/2010] [Accepted: 01/05/2011] [Indexed: 11/24/2022]
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Leutenegger M, Martin-Williams E, Harbi P, Thacher T, Raffoul W, André M, Lopez A, Lasser P, Lasser T. Real-time full field laser Doppler imaging. BIOMEDICAL OPTICS EXPRESS 2011; 2:1470-7. [PMID: 21698011 PMCID: PMC3114216 DOI: 10.1364/boe.2.001470] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 05/06/2011] [Accepted: 05/05/2011] [Indexed: 05/20/2023]
Abstract
We present a full field laser Doppler imaging instrument, which enables real-time in vivo assessment of blood flow in dermal tissue and skin. This instrument monitors the blood perfusion in an area of about 50 cm(2) with 480 × 480 pixels per frame at a rate of 12-14 frames per second. Smaller frames can be monitored at much higher frame rates. We recorded the microcirculation in healthy skin before, during and after arterial occlusion. In initial clinical case studies, we imaged the microcirculation in burned skin and monitored the recovery of blood flow in a skin flap during reconstructive surgery indicating the high potential of LDI for clinical applications. Small animal imaging in mouse ears clearly revealed the network of blood vessels and the corresponding blood perfusion.
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Affiliation(s)
- Marcel Leutenegger
- Laboratoire d’Optique Biomédicale, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Erica Martin-Williams
- Laboratoire d’Optique Biomédicale, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Pascal Harbi
- Aïmago SA, Parc Scientifique EPFL, Lausanne, Switzerland
| | - Tyler Thacher
- Aïmago SA, Parc Scientifique EPFL, Lausanne, Switzerland
| | - Wassim Raffoul
- Plastic Surgery Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Marc André
- Aïmago SA, Parc Scientifique EPFL, Lausanne, Switzerland
| | - Antonio Lopez
- Laboratoire d’Optique Biomédicale, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Philippe Lasser
- Service d'anesthésiologie, réanimation et antalgie, Etablissements hospitaliers du Nord Vaudois, Yverdon, Switzerland
| | - Theo Lasser
- Laboratoire d’Optique Biomédicale, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
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Mihara K, Shindo H, Ohtani M, Nagasaki K, Nakashima R, Katoh N, Kishimoto S. Early depth assessment of local burns by videomicroscopy: 24 h after injury is a critical time point. Burns 2011; 37:986-93. [PMID: 21596478 DOI: 10.1016/j.burns.2011.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Revised: 01/28/2011] [Accepted: 03/12/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE Videomicroscopy has simple and prompt operability, and useful in the burn depth assessment in its early phase. A burn wound is, however, a dynamic environment in the first few days and the critical time to assess a burn wound by videomicroscopy has not been investigated. The aim of this study is to investigate the critical time point to assess the burn depth by videomicroscopy. METHODS Forty one patients with 44 intermediate depth burns admitted within 7 days after injury were included. Accuracies were assessed by comparison with clinical outcome: healing within 21 days after injury or not with conservative treatment. We prospectively evaluated and compared the accuracy of the videomicroscopy measurements with the clinical assessments. All findings were serialized in order of time after injury and divided into three groups, and we compared the appreciation of burn depth by videomicroscopy findings among groups. RESULTS The videomicroscopy measurements is significantly accurate compared with clinical assessments (p=0.001). The accuracy of videomicroscopy measurements was significantly lower in the post-injury <24 h group compared with post-injury ≥24 h group (p=0.004). CONCLUSION Videomicroscopy is effective tool in assessment of early burn depth and the critical time point to assess the burn depth by videomicroscopy is 24 h after injury.
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Retrospective analysis of photographic evaluation of burn depth. Burns 2011; 37:69-73. [DOI: 10.1016/j.burns.2010.05.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2009] [Revised: 05/21/2010] [Accepted: 05/25/2010] [Indexed: 11/21/2022]
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Kaiser M, Yafi A, Cinat M, Choi B, Durkin AJ. Noninvasive assessment of burn wound severity using optical technology: a review of current and future modalities. Burns 2010; 37:377-86. [PMID: 21185123 DOI: 10.1016/j.burns.2010.11.012] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Revised: 08/30/2010] [Accepted: 11/10/2010] [Indexed: 11/19/2022]
Abstract
Clinical examination alone is not always sufficient to determine which burn wounds will heal spontaneously and which will require surgical intervention for optimal outcome. We present a review of optical modalities currently in clinical use and under development to assist burn surgeons in assessing burn wound severity, including conventional histology/light microscopy, laser Doppler imaging, indocyanine green videoangiography, near-infrared spectroscopy and spectral imaging, in vivo capillary microscopy, orthogonal polarization spectral imaging, reflectance-mode confocal microscopy, laser speckle imaging, spatial frequency domain imaging, photoacoustic microscopy, and polarization-sensitive optical coherence tomography.
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Affiliation(s)
- Meghann Kaiser
- Department of Surgery, Division of Trauma, Burns, Critical Care and Acute Care Surgery, University of California, Irvine, Orange, CA 92806, USA.
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Critical review of burn depth assessment techniques: part II. Review of laser doppler technology. J Burn Care Res 2010; 31:151-7. [PMID: 20061851 DOI: 10.1097/bcr.0b013e3181c7ed60] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The judgment of which wounds are expected to heal within 21 days is one of the most difficult and important tasks of the burn surgeon. The quoted accuracy of 64 to 76% by senior burn surgeons underscores the importance of an adjunct technology to help make this determination. A plethora of techniques have been developed in the last 70 years. Laser Doppler imaging (LDI) is one of the most recent and widely studied of these techniques. The technology provides an estimate of perfusion through the burn wound, the assumption being that a lower perfusion correlates with a deeper wound and, therefore, a longer time to heal. Although some reports suggest accuracy between 96 and 100% and that it does this 2 days ahead of clinical judgment, others have questioned its applicability to clinical practice. This article, the second of a two-part series, has two objectives: 1) a review of the Doppler principle and how the LDI uses it to estimate perfusion; and 2) a critical assessment of the burn literature on the LDI. Part I provides a historical perspective of the different technologies used through the last 70 years to assist in the determination of burn depth. Laser Doppler has brought technology closer to provide a reliable adjuvant to the clinical prediction of healing, yet, caution is warranted. A clear understanding of the limitations of LDI is needed to put the current research in perspective to find the right clinical application for LDI.
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Cutaneous microcirculatory assessment of the burn wound is associated with depth of injury and predicts healing time. Burns 2009; 36:477-82. [PMID: 19854578 DOI: 10.1016/j.burns.2009.06.195] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2009] [Revised: 06/24/2009] [Accepted: 06/24/2009] [Indexed: 01/07/2023]
Abstract
RATIONALE Current trends for the treatment of deep partial thickness and full-thickness burns include early excision and skin grafting. In this study we retrospectively evaluated the ability of Laser Doppler Flowmetry (LDF), taken within 24h of the burn to predict: (1) burn wound depth and (2) wounds which would heal in less than 21 days. METHOD The Laser Doppler Flowmeter (O2C, LEA Medizintechnik, Germany) was employed to non-invasively measure the cutaneous microcirculation of 173 selected areas on 28 patients who suffered burns. RESULTS A distinct association between initial flow (<24h after burn injury) and the clinical assessment of depth of burn wounds was observed. Wounds demonstrating an initial blood flow of >100 AU were, in 93.1% of cases, correctly (positively) predicted for spontaneous healing within 21 days. A blood flow of <100 AU (negatively) predicted in 88.2%, those wounds which would not go on to heal within 21 days. Sequential measurement analysis (<24h, 3 days after injury and 6 days after injury) revealed no significant decrease in skin perfusion velocity or flow rate. CONCLUSION LDF can provide immediate results for early determination of burn wound depth and is useful in selecting patients for conservative treatment of their burn wounds.
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Altintas AA, Altintas MA, Ipaktchi K, Guggenheim M, Theodorou P, Theodorou P, Amini P, Spilker G. Assessment of microcirculatory influence on cellular morphology in human burn wound healing using reflectance-mode-confocal microscopy. Wound Repair Regen 2009; 17:498-504. [PMID: 19614915 DOI: 10.1111/j.1524-475x.2009.00516.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Previous studies have assessed the effects of changes in microcirculation on wound healing; however, the influence of microcirculation on tissue histomorphology remains widely unknown. Reflectance-mode-confocal microscopy (RMCM) enables in vivo tissue observation on a cellular level. We present RMCM data evaluating the local microcirculation and assess the influence on histomorphology during burn healing. RMCM was performed in 12 patients (aged; 36.2+/-14.2 years, maximum-burn-extent: 4% total body surface area) at times 12, 36, and 72 hours after a superficial burn. The following parameters were assessed: quantitative blood-cell-flow (cbf), epidermal thickness (Emin), basal-layer thickness (tbl), and granular cell-size (Agran). Cbf was found to be 54+/-3.6 cells/minutes (control), increased to 91+/-3.6 cells/minutes (p<0.05) 12 hours postburn; decreased to 71+/-6.1 cells/minutes (p<0.05) (36 hours), and to 63+/-2.3 cells/minutes (p>0.05) 72 hours postburn. Emin was 43.74+/-3.87 mum (control), increased to 51.67+/-4.04 mum (p<0.05) 12 hours, decreased to 48.67+/-3.51 mum (p<0.05) 36 hours, and to 45.33+/-3.21 mum (p>0.05) at 72 hours postburn. Tbl was 14.17+/-0.6 mum (control), increased to 16.93+/-1.15 mum (p<0.05) 12 hours, decreased to 15.93+/-1.20 mum (p<0.05) 32 hours, and to 15.00+/-0.85 mum (p>0.05) 72 hours postburn. Agran was 718+/-56.20 mum(2) (control), increased to 901+/-66.02 mum(2) (p<0.05) 12 hours, decreased to 826+/-56.86 mum(2) 36 hours, and 766+/-65.06 mum(2) at 72 hours postburn. RMCM enables in vivo observation of wound microcirculation and allows direct assessment of vascular effects on cutaneous histomorphology during the healing course of superficial burns.
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Affiliation(s)
- Ahmet Ali Altintas
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center Cologne, University of Witten Campus Cologne Merheim, 51109 Cologne, Germany.
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Accuracy of early burn depth assessment by laser Doppler imaging on different days post burn. Burns 2008; 35:36-45. [PMID: 18952377 DOI: 10.1016/j.burns.2008.08.011] [Citation(s) in RCA: 167] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2007] [Accepted: 08/15/2008] [Indexed: 11/23/2022]
Abstract
BACKGROUND Accurate diagnosis of burn depth is essential in selecting the most appropriate treatment. Early assessment of burn depth by clinical means only has been shown to be inaccurate, resulting in unnecessary operations or delay of grafting procedures. Laser Doppler imaging (LDI) was reported as an objective technique to determine the depth of a burn wound, but the accuracy on very early days post burn has never been investigated yet. METHODS In 40 patients with intermediate depth burns, we prospectively evaluated and compared the accuracy of the LDI measurements with the clinical assessments on days 0, 1, 3, 5, 8. Clinical evaluation of the depth of the burn was performed by two observers blinded to the LDI images. Accuracies were assessed by comparison with outcome: healing times longer than 21 days were considered to be equivalent to a biopsy finding of a deep dermal wound. Obviously superficial and full thickness wounds were excluded. LDI flux level was used for LDI prediction of outcome: less than 220PU to predict non-healing at day 21. RESULTS The accuracies of burn depth assessments on the day of burn and post burn days 0, 1, 3, 5 and 8 using LDI were 54%, 79.5%, 95%, 97% and 100% compared with clinical assessment accuracies of 40.6%, 61.5%, 52.5%, 71.4% and 100%, respectively. LDI accuracy was significantly higher than clinical accuracy on day 3 (p<0.001) and day 5 (p=0.005). Burn depth conversion was also considered. This is the first study to quantify the advantage of LDI scanning over clinical assessments during these important early after burn days.
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