The FLIR ONE thermal imager for the assessment of burn wounds: Reliability and validity study

Influence of Infrared Thermography Predictors in Dental Implant Osteotomies: An Ex Vivo Study

OBJECTIVE

To evaluated the contribution of irrigation, drill type, motor, and dental implant system on infrared thermographic variations in osteotomies.

METHODS

Osteotomy sites for 240 implants were prepared with three implant systems (Arcys, NeoBiotech and Osstem), with 80 samples analyzed in each group. Each group was further subdivided according to the drilling conditions (with and without irrigation) and motor type (Coxo, W&H, Dentflex, Driller). The drill sequence included baseline, pilot, second and third drills at 1200 rpm and 40 Ncm. Infrared thermographic measurements were performed using a Fluke TiS55+ camera, with a resolution of 220 × 165 pixels and a temperature range of -20 °C to 450 °C. Statistical analysis consisted of ANOVA with Bonferroni post hoc test and linear regression model, with a view to evaluate the influence of the variables on final temperature changes.

RESULTS

Irrigation caused a much lower temperature across all implant systems (P < .001). When not irrigated, Arcys showed the highest temperatures, while in both NeoBiotech and Osstem the heat dissipated better. The Bonferroni post hoc test revealed no significant temperature difference existed among implant systems without irrigation. With irrigation, however, Arcys had a higher temperature than NeoBiotech and Osstem (P < .001). The type of motor had no statistically significant influence on the temperature of the final drilling (P > .05). Based on the regression analysis, the baseline, pilot, and second drill temperatures were the strongest predictors of the final drill temperature, with irrigation influencing the effects of the drill temperature.

CONCLUSION

Irrigation decreased the thermal stress during osteotomy, while NeoBiotech and Osstem showed better heat dispersing abilities. The motor type does not have a significant influence on the temperature differences. These findings establish the basic need for effective irrigation protocols to avoid thermal osteodisruption and promote osseointegration in implantology.

Application of infrared thermography for predicting pressure injury healing: A prospective study

BACKGROUND

An accurate assessment of pressure injury healing is crucial for the timely implementation of nursing intervention. This study aimed to investigate the accuracy of infrared thermography-based wound temperature measurement in predicting wound outcomes.

METHODS

This prospective, 16 days observational study included 156 adults with pressure injury. The temperature of wound bed, periwound skin and normal skin was recorded by using infrared thermography every three days. After that, three relative temperatures of PI were analyzed. The aim was to assess the significance of wound temperature in predicting healing outcomes for pressure injuries.

RESULTS

Relative temperature between periwound skin and normal skin was positively correlated with pressure injury healing (r > 0.64). Particularly the first day of follow up, it was found to be closely related to pressure injury healing (r = 0.687). On the last day and median time (the eighth to ninth day) of follow up, the optimal cutoff values of the indicator were negative values (periwound skin temperature was lower than normal skin). COX proportional hazard regression model analysis showed that relative temperature between periwound skin and normal skin on the first day of follow-up was the most significant predictor of pressure injury healing, and the healing risk increased largest- 8.79 times (95%CI: 4.53, 17.05), when its temperature greater than 0.000 °C.

CONCLUSION

Relative temperature between periwound skin and normal skin monitoring by infrared thermography better than visual assessment which can objectively serve as an indicator for predicting the healing status of pressure injury.

Thermal Rejection Assessment: New Strategies for Early Detection

Skin pigmentation can pose challenges for physicians to diagnose pathologies. In Vascularized Composite Allotransplantation (VCA), this increases the difficulty of diagnosing rejection by clinical observation, which could be improved by noninvasive monitoring, thereby completely avoiding or aiding in guiding location for invasive diagnostics. In this study, pigmented and non-pigmented allogeneic and non-pigmented syngeneic control transplant recipients underwent daily thermal assessment using infrared (IR) gun and forward-looking IR (FLIR) imaging of VCAs using a rodent partial hindlimb transplant model. Daily clinical assessment was performed, and biopsies were taken on postoperative day (POD) 1, 3, and 7. Clinical and histological assessments indicated signs of rejection on POD 3. In contrast, thermal assessment using the IR gun detected significant differences as early as POD 1, notably a decrease in temperature, when comp ared to syngeneic control transplants. This demonstrates the capability of thermal assessments to identify early signs of rejection before clinical symptoms become apparent. The findings suggest that thermal assessments can serve as a non-contact, objective adjunct tool for early detection of graft rejection, with consideration of skin pigmentation. This approach may reduce the need for invasive biopsies, thereby improving patient comfort and reducing potential complications associated with current diagnostic methods.

Assessing detector stability and image quality of thermal cameras on smartphones for medical applications: a comparative study

INTRODUCTION

Infrared thermography (IRT) has gained significant interest in medical applications for its potential in diagnosing various conditions. Smartphone-based IRT modules offer portability and affordability, leading to increased utilization in medical settings. However, differences in performance among these modules raise questions about their reliability for medical use.

MATERIALS AND METHODS

This study compared three smartphone-based IRT modules (SmartIRT-Hikmicro, FLIR One Pro, and Seek Thermal CompactPRO-which, according to their datasheets, exhibit comparable quality and parameters. Temperature stability, surface temperature of the body, and spatial uniformity of provided images were assessed using calibrated black body measurements and surface temperature monitoring.

RESULTS

The Hikmicro module exhibited the most stable temperature readings, while FLIR One Pro showed the highest temperature increase over time. Seek Thermal CompactPRO demonstrated relatively better spatial uniformity. However, discrepancies in image resolution were noted, with FLIR One and Seek modules modifying image sizes through post-processing algorithms.

CONCLUSION

While SmartIRT modules offer affordability and portability, their performance varies significantly. Temporal stability emerges as a critical factor, with the Hikmicro module demonstrating leadership in this aspect. Careful consideration and validation are necessary when selecting and utilizing SmartIRT modules for medical applications.

The use of smartphone thermography to evaluate wound healing in second-degree burns

BACKGROUND

Burn injuries can significantly affect a person's ability to function and reduce their quality of life. This study used thermal imaging to investigate the relationship between blood flow changes and healing in second-degree burns. The researchers hypothesized that improved blood flow to the burn site, as indicated by infrared thermography assessments, may be associated with better wound healing outcomes in patients with second-degree burns.

PATIENTS AND METHODS

This prospective, non-randomized study included 47 adults with second-degree burns who underwent a structured program of range of motion (ROM) exercises during the healing process. Wound healing progression was assessed by infrared thermography (FLIR imaging) to measure temperature differences (ΔT) between burn wounds (T2) and normal skin (T1) as an indirect marker of perfusion; the modified Abbreviated Burn Severity Index (mABSI) to classify burn severity levels; and the Bates-Jensen Wound Assessment Tool (BWAT). Measurements were taken at baseline, week one, week two, and week three following the initiation of ROM exercises.

RESULTS

The ABSI levels showed that 46.8 % of patients had moderate severity burns, 38.3 % had very low severity, and 14.9 % had moderately severe burns. BWAT scores showed a decreasing trend over a three-week period. They began at 28.9 ± 4.6 SD, rose slightly to 30.1 ± 4.7 SD after one week indicating inflammation and wound changes, and then dropped to 19.2 ± 6.5 SD and 17.1 ± 4.3 SD in the second and third weeks respectively showing substantial healing. FLIR thermal imaging was also used to monitor the healing process by measuring the temperature difference (ΔT) between the burn wound (T2) and normal skin (T1). Larger ΔT values suggest better blood flow (perfusion) and potentially improved healing. The median ΔT values decreased over the three weeks, starting at 0.60 (IQR 1.65) and falling to 0.01 (IQR 0.20) by week three. These changes in ΔT over time were statistically significant (p < 0.001, Kruskal-Wallis test).

CONCLUSIONS

This study successfully used FLIR thermal imaging in patients undergoing a rehabilitation program focused on ROM exercises, showing a positive link with healing progress. The findings highlight the potential of FLIR thermal imaging to optimize burn management and improve patient outcomes. Further research is needed to validate these findings and develop standardized protocols for both ROM exercises and thermal imaging to enhance burn care.

Post-operative monitoring of tissue perfusion in murine skin flaps using enhanced thermal imaging

Inadequate tissue perfusion is a fundamental cause of early complications following a range of surgeries. We are developing a real-time infrared imaging technique, enhanced thermal imaging (ETI), to detect blood vessels embedded in soft tissue. This study evaluated the potential of ETI to detect capillary growth as an indicator of early wound healing in murine skin flaps. The relationship between vessel density and the thermal signal observed with ETI was explored using MATLAB simulations of a geometrically simplified vascularized tissue model. Simulations showed that increased vessel density corresponded to a greater thermal response at the tissue surface. This trend suggests experimental ETI measurements were related to angiogenesis during wound healing. Studies using a similarly grafted murine model confirmed the presence of angiogenesis with physical vessel counts in fluorescence-labeled frozen sections.

Harnessing Manuka Honey: A Natural Remedy for Accelerated Burn Wound Healing in a Porcine Model

Backgrounds: Burn injuries present significant medical challenges due to their complexity in healing and potential for severe scarring. This study evaluates the efficacy of Manuka honey in accelerating burn wound healing compared to conventional antibiotic ointments. Methods: Using a porcine model resembling human skin, nine Landrace breed female pigs with standardized deep dermal burns were treated with either Manuka honey in alginate or a combination of antibiotic ointments. Wound healing was assessed through macroscopic evaluation, a histopathological analysis, and immunohistochemical staining over a 60-day period. Results: Our findings indicate that the Manuka honey treatment was associated with significantly increased collagen density in the treated wounds compared to the control group (p < 0.05). The immunohistochemical analysis revealed lower macrophage activity (Iba1 staining) and a reduction in Ki67 expression on days 10 and 17 in the Manuka honey group, suggesting a more rapid transition toward tissue remodeling. The quantitative analysis showed a trend toward delayed epithelialization and increased inflammation in the control group, while wounds treated with Manuka honey exhibited faster reepithelialization and improved epidermal regeneration. However, additional studies are required to further assess collagen fiber organization and overall dermal architecture. Conclusions: These findings support the potential of Manuka honey as a beneficial treatment for burn wound healing, with evidence of enhanced reepithelialization and collagen deposition. Further research, including clinical trials, is necessary to fully elucidate its role in clinical practice and optimize treatment protocols.

The role of thermography in assessment of wounds. A scoping review

Assessment of wounds based on visual appearance has poor inter- and intra-rater reliability and it is difficult to differentiate between inflammation and infection. Thermography is a user-friendly quantitative image technique that collects the skin surface temperature pattern of the wound area and immediately visualizes the temperatures as a rainbow coloured diagram. The aim of this scoping review is to map and summarize the existing evidence on how thermography has been used to assess signs of inflammation in humans and animals with surgical or traumatic wounds. The method follows the Joanna Briggs Institute methodology. The databases searched were PubMed, Embase, CINAHL and Cochrane Library. 3798 sources were identified, 2666 were screened on title and abstract, 99 on full text and 19 studies were included for review. We found that the literature is diverse and originates from a variety of scientific fields. Thermography has been used to detect and predict inflammation and infection in surgical wounds. Grading systems based on the visual appearance correlate to temperature patterns detected with thermography. The general tendency is that thermography detects the temperature in a wound with inflammation to be warmer than a reference area or the same skin area before surgery. In a surgical wound the temperature is elevated 1-2 weeks after surgery due to natural physiological inflammation that induces healing, after 2 weeks the temperature of the wound area slowly and steady decreases to baseline over 1-3 months. If a secondary temperature peak happens during the healing phase of a surgical wound, it is likely that infection has occurred. Modern handheld thermographic cameras might be a promising tool for the clinician to quickly quantify the temperature pattern of surgical wounds to distinguish between inflammation and infection. However, firm evidence supporting infection thermography surveillance of surgical wounds as a technique is missing.

Thermal Imaging for Burn Wound Depth Assessment: A Mixed-Methods Implementation Study

Background: Implementing innovations emerging from clinical research can be challenging. Thermal imagers provide an accessible diagnostic tool to increase the accuracy of burn wound depth assessment. This mixed-methods implementation study aimed to assess the barriers and facilitators, design implementation strategies, and guide the implementation process of thermal imaging in the outpatient clinic of a burn centre. Methods: This study was conducted between September 2022 and February 2023 in Beverwijk, The Netherlands. Semi-structured interviews with burn physicians guided by the Consolidated Framework for Implementation Research (CFIR) were conducted to identify barriers and facilitators. Based on the barriers, implementation strategies were developed with the CFIR-ERIC Matching Tool, and disseminated to support the uptake of the thermal imager. Subsequently, thermal imaging was implemented in daily practice, and an iterative RE-AIM approach was used to evaluate the implementation process. Results: Common facilitators for the implementation of the thermal imager were the low complexity, the relative advantage above other diagnostic tools, and benefits for patients. Common barriers were physicians' attitude towards and perceived value of the intervention, the low compatibility with the current workflow, and a lack of knowledge about existing evidence. Six implementation strategies were developed: creating a formal implementation blueprint, promoting adaptability, developing educational materials, facilitation, conducting ongoing training, and identifying early adopters. These strategies resulted in the effective implementation of the thermal imager, reflected by a >70% reach among eligible patients, and >80% effectiveness and adoption. Throughout the implementation process, compatibility, and available resources remained barriers, resulting in low ratings on RE-AIM dimensions. Conclusions: This study developed implementation strategies based on the identified CFIR constructs that impacted the implementation of a thermal imager for burn wound assessment in our outpatient clinic. The experiences and findings of this study could be leveraged to guide the implementation of thermal imaging and other innovations in burn care.

Accuracy of infrared thermography evaluation in burn wound healing: a systematic review and meta-analysis

OBJECTIVE

Accurate assessment of burn depth and burn wound healing potential is essential to determine early treatments. Infrared thermography (IRT) is a non-invasive and objective tool to do this. This systematic review evaluated the accuracy of IRT to determine burn wound healing potential.

METHOD

This systematic review and meta-analysis used MEDLINE, EMBASE, CINAHL, PEDro, DiTA and CENTRAL databases. IRT data were extracted from primary studies and categorised into four cells (i.e., true positives, false positives, true negatives and false negatives). Subgroup analysis was performed according to methods used to capture thermal images.

RESULTS

The search strategy identified 2727 publications; however, 15 articles were selected for review and 11 for meta-analysis. In our meta-analysis, the accuracy of IRT was 84.8% (63% sensitivity and 81.9% specificity).

CONCLUSION

IRT is a moderately accurate tool to identify burn depth and healing potential. Thus, IRT should be used carefully for evaluating burn wounds.

Prewarming Parturients for Cesarean Section Does Not Raise Wound Temperature But Body Heat and Level of Comfort: A Randomized Trial

PURPOSE

Prewarming before cesarean section lowers the rates of surgical site infections (SSIs). We hypothesized that this effect is explained due to a higher core temperature resulting in a higher wound temperature.

DESIGN

We conducted an open-labeled randomized study with on-term parturients scheduled for elective cesarean section under spinal anesthesia. Participants were randomized into an intervention group (prewarming) and a control group.

METHODS

Core and wound temperature, comfort level, and examination results were taken at defined times until discharge from the postanesthesia care unit (PACU). There was a follow-up visit and interview 1 day after the procedure. The primary outcome was a difference in wound temperature. The secondary outcomes were differences in core temperature, patient comfort, blood loss, SSI, and neonatal outcome.

FINDINGS

We randomized a total of 60 patients, 30 per group. Prewarming lead to a significantly higher core temperature. Additionally, patient comfort was significantly higher in the prewarming group even after discharge from PACU. We did not find a difference in wound temperature, SSI, neonatal outcome, or blood loss.

CONCLUSIONS

Prewarming before cesarean section under spinal anesthesia maintains core temperature and improves patient comfort but does not affect wound temperature.

Thermographic assessment of skin temperature after lumbar spine surgery: Useful method for detection of wound complications? A pilot study

BACKGROUND

Wound complications after lumbar spine surgery may result in prolonged hospitalization and increased morbidity. Early identification can trigger appropriate management.

OBJECTIVE

The aim of this study was to investigate the efficacy of infrared-based wound assessment (FLIR) after lumbar spine surgery in the context of identifying wound healing disorders.

METHODS

62 individuals who underwent lumbar spine surgery were included. The immediate postoperative course was studied, and the patient's sex, age, body mass index (BMI), heart rate, blood pressure, body temperature, numeric rating scale for pain (NRS), C-reactive protein (CRP), leukocyte, and hemoglobin levels were noted and compared to thermographic measurement of local surface temperature in the wound area.

RESULTS

Measurement of local surface temperature in the wound area showed a consistent temperature distribution while it was uneven in case of wound healing disorder. In this instance, the region of the wound where the wound healing disorder occured had a lower temperature than the surrounding tissue (p> 0.05).

CONCLUSIONS

This study demonstrates the ongoing importance of clinical wound assessment for early detection of complications. While laboratory parameter measurement is crucial, FLIR may serve as a cost-effective supplemental tool in clinical wound evaluation. Patient safety risks appear minimal since local ST is measured without touch.

A Deep Learning Image-to-Image Translation Approach for a More Accessible Estimator of the Healing Time of Burns

OBJECTIVE

An accurate and timely diagnosis of burn severity is critical to ensure a positive outcome. Laser Doppler imaging (LDI) has become a very useful tool for this task. It measures the perfusion of the burn and estimates its potential healing time. LDIs generate a 6-color palette image, with each color representing a healing time. This technique has very high costs associated. In resource-limited areas, such as low- and middle-income countries or remote locations like space, where access to specialized burn care is inadequate, more affordable and portable tools are required. This study proposes a novel image-to-image translation approach to estimate burn healing times, using a digital image to approximate the LDI.

METHODS

This approach consists of a U-net architecture with a VGG-based encoder and applies the concept of ordinal classification. Paired digital and LDI images of burns were collected. The performance was evaluated with 10-fold cross-validation, mean absolute error (MAE), and color distribution differences between the ground truth and the estimated LDI.

RESULTS

Results showed a satisfactory performance in terms of low MAE ( 0.2370 ±0.0086). However, the unbalanced distribution of colors in the data affects this performance.

SIGNIFICANCE

This novel and unique approach serves as a basis for developing more accessible support tools in the burn care environment in resource-limited areas.

Direct relationship between evapotranspiration rate (ETO) and vertebrate decomposition rate

When vertebrate scavenging is excluded, the Evapotranspiration Rate (ETo) of a given geographic region directly regulates the decomposition rate of unclothed vertebrate carrion, with any deviation attributed to insect activity. We conducted four decomposition experiments using pig carrion (Sus scrofa domesticus) over the span of two years (2018-2020) at a location in Davis, California. We used ETo, a variable that accounts for five climatic parameters (wind, temperature, humidity, solar radiation, and altitude) as the rate-determining variable of the decomposition process. We found ETo to have a strong (R2 = 0.98) predictive relationship with the decomposition rate. To account for maggot activity decomposing the carrion, we measured maggot weight in 2019 and 2020 using a novel method, and in 2020 we used FLIR imagery to measure maggot mass temperatures as a surrogate measurement of total maggot activity. Maggot activity was a significant predictor (p < 0.0001) of the decomposition rate, while maggot weight was not (p > 0.1). We hope to show the forensic entomology community the potential of using ETo. Future projects can incorporate ETo as a baseline to decomposition studies to determine if ETo remains the most accurate descriptor of decomposition and ultimately increase certainty in the Postmortem Interval (PMI).

Wound pH and temperature as predictors of healing: an observational study

OBJECTIVE

The aim of this study was to measure wound pH, wound temperature and wound size together to gain further understanding of their impact as predictors of wound healing outcomes.

METHOD

This study employed a quantitative non-comparative, prospective, descriptive observational design. Participants with both acute and hard-to-heal (chronic) wounds were observed weekly for four weeks. Wound pH was measured using pH indicator strips, wound temperature was measured using an infrared camera and wound size was measured using the ruler method.

RESULTS

Most of the 97 participants (65%, n=63) were male; participant's ages ranged between 18 and 77 years (mean: 42±17.10. Most of the wounds observed were surgical 60%, (n=58) and 72% (n=70) of the wounds were classified as acute, with 28% (n=27) classified as hard-to-heal wounds. At baseline, there was no significant difference in pH between acute and hard-to-heal wounds; overall the mean pH was 8.34±0.32, mean temperature was 32.86±1.78°C) and mean wound area was 910.50±1132.30mm2. In week 4, mean pH was 7.71±1.11, mean temperature was 31.90±1.76°C and mean wound area was 339.90±511.70mm2. Over the study follow-up period, wound pH ranged from 5-9, from week 1 to week 4, mean pH reduced by 0.63 units from 8.34 to 7.71. Furthermore, there was a mean 3% reduction in wound temperature and a mean 62% reduction in wound size.

CONCLUSION

The study demonstrated that a reduction in pH and temperature was associated with increased wound healing as evidenced by a corresponding reduction in wound size. Thus, measuring pH and temperature in clinical practice may provide clinically meaningful data pertaining to wound status.

COMPUTER SYSTEMS TO AID IN WOUND HEALING: SCOPE REVIEW

Objective: To investigate studies that present computational systems to aid healing and systems which refer to the use of low-level laser.Method: Scope review that aimed to answer the question: Which computer systems help in wound healing? A subquestion was: Which of the computer systems refer to the use of low-level laser? Results: From the search, applying the eligibility criteria, 49 articles made up the final sample. The systems served multiple purposes in support of wound healing; the majority presented the health professional as a user of the system; medicine was the most mentioned professional area despite nursing being involved in the management of care for people with wounds. Innovation in care using the computer system was frequently reported, demonstrating the importance of this type of tool for clinical practice. There was a high frequency of the mobile platform, showing that this is a current trend. Conclusion:Computer systems have been used as tools to support patients and especially professionals in wound healing. Regarding the systems aimed at the low intensity laser, there was a shortage of computer systems for this purpose, with a study.

The effect of Tarantula cubensis D6 on zone of stasis in a rat burn model

AIM

Burn injuries are one of the most devastating injuries. Saving the zone of stasis decreases burn size, morbidity, and mortality. Tarantula cubensis (TC) increases epithelization of wounds, and increases wound contraction. In this study, we investigated the effects of TC on the stasis zone.

MATERIALS AND METHODS

36 Wistar albino female rats were divided into 3 groups. Using brass comb burn model, at days 0 and 3, physiological serum solution in group 2, TC injection in group 3and no injection in group 1 was applied. Thermal and normal images were taken on day 10 and rats were sacrificed for histopathological examination.

RESULTS

We found a statistically significant difference between the 1st and 3rd group, 2nd and 3rd group regarding viable wound areas (p < 0.05), temperature difference (body-stasis zone) and mean body temperature (p < 0.05). We found no statistically significant difference between groups regarding neovascularization, inflammatory density, and vital cutaneous appendages. We found a statistically significant difference in epithelial layer thickness between the1st and 3rd groups, 2nd and 3rd groups(p < 0.05).

CONCLUSION

TC increases stasis zone viability macroscopically, increases epithelial layer thickness histopathologically, thus it promotes wound healing in burn wounds. This increase in stasis zone viability was also established with thermal imaging.

SISTEMAS COMPUTACIONAIS PARA AUXÍLIO NA CICATRIZAÇÃO DE FERIDAS: REVISÃO DE ESCOPO

Objetivo:Investigar estudos que apresentem sistemas computacionais de auxílio à cicatrização de feridas e quais sistemas se referem ao uso de laser de baixa intensidade. Método: Revisão de escopo que visou responder à questão de pesquisa: Quais sistemas computacionais auxiliam na cicatrização de feridas? Uma subquestão foi: quais sistemas computacionais se referem ao uso do laser de baixa intensidade? Resultados: A partir da busca, aplicando os critérios de elegibilidade, 49 artigos compuseram a amostra final. Os sistemas apresentaram várias finalidades de apoio à cicatrização de feridas, em que a maioria apresentou como usuário do sistema o profissional de saúde, sendo a medicina a área profissional mais mencionada, embora a enfermagem esteja envolvida com o manejo do cuidado às pessoas com feridas. Foi relatada com frequência a inovação na assistência a partir do uso do sistema computacional, o que demonstra a importância desse tipo de ferramenta para a prática clínica. Verificou-se com frequência o uso de plataforma mobile, como tendência da atualidade. Conclusão: Os sistemas computacionais têm sido utilizados como ferramentas para apoiar pacientes e principalmente profissionais na cicatrização de feridas. Quanto ao laser de baixa intensidade, houve escassez de sistemas computacionais com essa finalidade, com apenas um estudo.

Precision of Dynamic Infrared Thermography in Anterolateral Thigh Flap Planning: Identification of the Perforator Fascia Passage

Background The anterolateral thigh (ALT) flap is commonly utilized in reconstructive surgery. Preoperative perforator mapping facilitates dissection. Dynamic infrared thermography can be applied to identify ALT perforators. However, its accuracy has not been evaluated in detail before. Therefore, this study aimed to assess the precision of dynamic infrared thermography in ALT perforator localization.

Methods The survey site was defined as a 25 × 8 cm rectangle on the anterolateral thigh and a coordinate system was established. The area was examined consecutively by dynamic infrared thermography with a FLIR ONE camera after 2-minute fan precooling. Two surgeons then independently performed color duplex ultrasound on the basis of the identified hotpots.

Results Twenty-four healthy subjects were examined. About 74.8% of perforators were musculocutaneous or musculoseptocutaneous. The mean distance between study area center and perforator or hotspot center was 51.8 ± 27.3 and 46.5 ± 26.2 mm, respectively. The mean distance from hotspot center to sonographic perforator fascia passage was 15.9 ± 9.9 mm with a maximum of 48.4 mm. The positive predictive value of thermographic ALT perforator identification was 93%.

Conclusion Thermographic hotspot and perforator location diverge widely in ALT flaps. Dynamic infrared thermography can therefore not be used as standalone technique for preoperative ALT perforator identification. However, the application before color duplex ultrasound examination is a reasonable upgrade and can visualize angiosomes and facilitate the examination.

Evaluation of the Influence of Short Tourniquet Ischemia on Tissue Oxygen Saturation and Skin Temperature Using Two Portable Imaging Modalities

BACKGROUND

The exact influence of tourniquet ischemia on a treated extremity remains unclear.

METHODS

Twenty patients received an operation on one hand under tourniquet ischemia. Twenty healthy volunteers received 10 min of tourniquet ischemia on one of their arms. Measurements of tissue oxygen saturation using near-infrared reflectance-based imaging and skin temperature of the dorsum of the hand were performed at five different timepoints (t0 was performed just before the application of the tourniquet ischemia, t1 directly after the application of the tourniquet ischemia, t2 before the release of the ischemia, t3 directly after the release of the ischemia, and t4 on the following day).

RESULTS

In both groups, tissue oxygen saturation dropped after the application of the tourniquet ischemia compared to t0 and increased after the release of the tourniquet ischemia. In the patient group, tissue oxygen saturation at t4 was higher compared to t0; in contrast, the level of tissue oxygen saturation in the participant group dropped slightly at t4 compared to t0. The measured skin temperature in the patient group showed an increase during the observation period, while it continuously decreased in the group of healthy participants.

CONCLUSIONS

Short-term ischemia did not appear to permanently restrict perfusion in this study design. The non-invasive imaging modalities used were easy to handle and allowed repetitive measurement.

The Use of Infrared Thermography (IRT) in Burns Depth Assessment: A Diagnostic Accuracy Meta-Analysis

BACKGROUND

The timely diagnosis of burns depth is crucial to avoid unnecessary surgery and delays in adequate management of patients with burn injuries. Whilst it is mostly a clinical diagnosis, indocyanine green, laser Doppler imaging and infrared thermography have been used alongside clinical findings to support the diagnosis. Infrared thermography is a noninvasive technique which uses temperature differences to diagnose tissue burn depth. Our study aims to assess its use in differentiating between superficial and deep burns.

METHODS

We conducted a systematic literature review and meta-analysis using electronic databases. We used a mixed-effects logistic regression bivariate model to estimate summary sensitivity and specificity and developed hierarchical summary receiver operating characteristic (HSROC) curves.

RESULTS

We identified 6 studies reporting a total of 197 burns, of which 92 were proven to be deep burns. The reference standard was clinical assessment at the time of injury and burn healing time. The pooled estimates for sensitivity and specificity were 0.84 (95% CI 0.71-0.92) and 0.76 (95% CI 0.56-0.89), respectively.

CONCLUSIONS

IRT is a promising burns assessment modality which may allow surgeons to correctly classify burn injuries at the time of presentation. This will allow a more efficient management of burns and timely surgical intervention.

Stretchable printed device for the simultaneous sensing of temperature and strain validated in a mouse wound healing model

Temperature and strain are two vital parameters that play a significant role in wound diagnosis and healing. As periodic temperature measurements with a custom thermometer or strain measurements with conventional metallic gauges became less feasible for the modern competent health monitoring, individual temperature and strain measurement modalities incorporated into wearables and patches were developed. The proposed research in the article shows the development of a single sensor solution which can simultaneously measure both the above mentioned parameters. This work integrates a thermoelectric principle based temperature measurement approach into wearables, ensuring flexibility and bendability properties without affecting its thermo-generated voltage. The modified thermoelectric material helped to achieve stretchability of the sensor, thanks to its superior mechano-transduction properties. Moreover, the stretch-induced resistance changes become an additional marker for strain measurements so that both the parameters can be measured with the same sensor. Due to the independent measurement parameters (open circuit voltage and sensor resistance), the sensing model is greatly attractive for measurements without cross-sensitivity. The highly resilient temperature and strain sensor show excellent linearity, repeatability and good sensitivity. Besides, due to the compatibility of the fabrication scheme to low-temperature processing of the flexible materials and to mass volume production, printed fabrication methodologies were adopted to realize the sensor. This promises low-cost production and a disposable nature (single use) of the sensor patch. For the first time, this innovative temperature-strain dual parameter sensor concept has been tested on mice wounds in vivo. The preliminary experiments on mice wounds offer prospects for developing smart, i.e. sensorized, wound dressings for clinical applications.

Thermotropic Liquid Crystals for Temperature Mapping

Wound management in Space is an important factor to be considered in future Human Space Exploration. It demands the development of reliable wound monitoring systems that will facilitate the assessment and proper care of wounds in isolated environments, such as Space. One possible system could be developed using liquid crystal films, which have been a promising solution for real-time in-situ temperature monitoring in healthcare, but they are not yet implemented in clinical practice. To progress in the latter, the goal of this study is twofold. First, it provides a full characterization of a sensing element composed of thermotropic liquid crystals arrays embedded between two elastomer layers, and second, it discusses how such a system compares against non-local infrared measurements. The sensing element evaluated here has an operating temperature range of 34–38°C, and a quick response time of approximately 0.25 s. The temperature distribution of surfaces obtained using this system was compared to the one obtained using the infrared thermography, a technique commonly used to measure temperature distributions at the wound site. This comparison was done on a mimicked wound, and results indicate that the proposed sensing element can reproduce the temperature distributions, similar to the ones obtained using infrared imaging. Although there is a long way to go before implementing the liquid crystal sensing element into clinical practice, the results of this work demonstrate that such sensors can be suitable for future wound monitoring systems.

Assessment of Mastectomy Skin Flaps for Immediate Reconstruction with Implants via Thermal Imaging-A Suitable, Personalized Approach?

BACKGROUND

Impaired perfusion of the remaining skin flap after subcutaneous mastectomy can cause wound-healing disorders and consecutive necrosis. Personalized intraoperative imaging, possibly performed via the FLIR ONE thermal-imaging device, may assist in flap assessment and detect areas at risk for postoperative complications.

METHODS

Fifteen female patients undergoing elective subcutaneous mastectomy and immediate breast reconstruction with implants were enrolled. Pre-, intra- and postoperative thermal imaging was performed via FLIR ONE. Potential patient-, surgery- and environment-related risk factors were acquired and correlated with the occurrence of postoperative complications.

RESULTS

Wound-healing disorders and mastectomy-skin-flap necrosis occurred in 26.7%, whereby areas expressing intraoperative temperatures less than 26 °C were mainly affected. These complications were associated with a statistically significantly higher BMI, longer surgery duration, lower body and room temperature and a trend towards larger implant sizes.

CONCLUSION

Impaired skin-flap perfusion may be multifactorially conditioned. Preoperative screening for risk factors and intraoperative skin-perfusion assessment via FLIR ONE thermal-imaging device is recommendable to reduce postoperative complications. Intraoperative detectable areas with a temperature of lower than 26 °C are highly likely to develop mastectomy-skin-flap necrosis and early detection allows individual treatment concept adaption, ultimately improving the patient's outcome.

Characterization of Baseline Temperature Characteristics Using Thermography in The Clinical Setting

BACKGROUND

Thermography is a diagnostic method based on the ability to record infrared radiation emitted by the skin and is unique in its ability to accurately show physiological and/or pathological cutaneous temperature changes in a non-invasive way. This method can be used to indirectly assess changes or impairments in cutaneous perfusion. Significant technological advancements have allowed thermography to be more commonly utilized by clinicians, yet a basic consensus of patient characteristics that may affect temperature recordings is not established.

MATERIALS AND METHODS

We evaluated cutaneous temperature in a cohort of outpatients to understand what factors, including tobacco use and other high-risk characteristics, contribute to cutaneous tissue perfusion as measured by thermography. Participants were prospectively enrolled if they were a combustible cigarette smoker, an electronic cigarette (e-cigarette) user, or a never smoker. Standardized thermographic images of the subject's facial profiles, forearms, and calves were taken and demographic characteristics, medical comorbidities, and tobacco product use were assessed. These variables were statistically tested for associations with temperature at each anatomic site.

RESULTS

We found that gender had a significant effect on thermographic temperature that differed by anatomic site, and we found a lack of significant difference in thermographic temperature by race. Our regression analysis did not support significant differences in thermographic temperatures across smoking groups, while there was a trend for decreased perfusion in smokers relative to non-smokers and e-cigarette users relative to non-smokers.

CONCLUSION

Thermographic imaging is a useful tool for clinical and research use with consideration of sex and other perfusion-affecting characteristics.

Is the quality of mobile health applications for burns being adequately assessed?

High quality mobile health applications (mhealth apps) have the potential to enhance the prevention, diagnosis and treatment of burns. The primary aim of this study was to evaluate whether the quality of mhealth apps for burns care is being adequately assessed. The secondary aim was to determine whether these apps meet regulatory standards in the UK. We searched AMED, BNI, CINAHL, Cochrane library, Embase, Emcare, Medline and PsychInfo to identify studies assessing mhealth app quality for burns. The PRISMA reporting guideline was adhered to. Two independent reviewers screened abstracts to identify relevant studies. The quality of identified studies was assessed according to the framework proposed by Nouri et al, including design, information/content, usability, functionality, ethical issues, security/privacy and user-perceived value. Of the 28 included studies, none assessed all seven domains of quality. Design was assessed in 4/28 studies; information/content in 26/28 studies; usability in 12/28 studies; functionality in 10/28 studies; ethical issues were never assessed in any studies; security/privacy was not assessed; subjective assessment was made in 9/28 studies. 17/28 studies included apps that met the definition of 'medical device' according to MHRA guidance, yet only one app was appropriately certified with the UK Conformity Assessed (UKCA) mark. The quality of mHealth apps for burns are not being adequately assessed. The majority of apps should be considered medical devices according to UK standards, yet only one was appropriately certified. Regulatory bodies should support mhealth app developers, so as to improve quality control whilst simultaneously fostering innovation.

Thermal, Hyperspectral, and Laser Doppler Imaging: Non-Invasive Tools for Detection of The Deep Inferior Epigastric Artery Perforators-A Prospective Comparison Study

Perforator flaps have become one of the leading procedures in microsurgical tissue transfer. Individual defects require a tailored approach to guarantee the most effective treatment. A thorough understanding of the individual vascular anatomy and the location of prominent perforators is of utmost importance and usually requires invasive angiography or at least acoustic Doppler exploration. In this study, we aimed at evaluating different non-invasive imaging modalities as possible alternatives for perforator location detection. After a cooling phase, we performed thermal, hyperspectral and Laser Doppler imaging and visually evaluated a possible detection of the perforator for a period of five minutes with an image taken every minute. We identified the most prominent perforator of the deep inferior epigastric artery by handheld acoustic Doppler in 18 patients. The detected perforator locations were then correlated. Eighteen participants were assessed with six images each per imaging method. We could show a positive match for 94.44%, 38.89%, and 0% of patients and 92.59%, 25.93%, and 0% of images for the methods respectively compared to the handheld acoustic Doppler. Sex, age, abdominal girth, and BMI showed no correlation with a possible visual detection of the perforator in the images. Therefore, thermal imaging can yield valuable supporting data in the individualized procedure planning. Future larger cohort studies are required to better assess the full potential of modern handheld thermal imaging devices.

Air Flow Cooling Improves Anterolateral Thigh Perforator Mapping Using the FLIR ONE Thermal Camera

BACKGROUND

 Due to the variable vascular anatomy preoperative perforator mapping facilitates anterolateral thigh (ALT) free flap harvesting. Dynamic infrared perforator imaging can assist preoperative planning by displaying hot spots that represent angiosomes. This study aims to compare previously described precooling methods to develop a standardized simplified protocol for ALT perforator planning.

METHODS

 Fifty thighs were examined with a FLIR ONE thermal camera. Four different cold challenges, including alcoholic disinfection, wet laparotomy sponge cooling, fan cooling, and cold pack application, were compared. Hot spot locations within a 250 mm × 80 mm area were compared double-blinded to perforator locations determined by Doppler ultrasonography considered as gold standard.

RESULTS

 The matching rate of thermographic hot spots and sonographically identified perforators was 34.9 ± 22.2%. An increased matching rate of 62.2 ± 42.2% was noted taking only favored perforators (septocutaneous course, diameter >1 mm, distance <3 cm to the center, and visible concomitant veins) into account. Precooling with a fan followed by alcoholic disinfection provided clearest thermograms and fastest results.

CONCLUSION

 Thermographic imaging is a reliable method for perforator imaging. Its supplemental use to ultrasound may reduce examination time and yield additional information. Precooling by air flow or alcoholic disinfection can be easily implemented and provide the best thermograms. The matching rate of thermographic hot spots and perforators increases when taking only clinically relevant perforators into account. Thermal perforator mapping therefore reduces distraction by negligible perforators.

Use of Infrared Thermography for Assessment of Burn Depth and Healing Potential: A Systematic Review

INTRODUCTION

Burn wound depth assessments are an important component of determining patient prognosis and making appropriate management decisions. Clinical appraisal of the burn wound by an experienced burn surgeon is standard of care but has limitations. IR thermography is a technology in burn care that can provide a non-invasive, quantitative method of evaluating burn wound depth. IR thermography utilizes a specialized camera that can capture the infrared emissivity of the skin, and the resulting images can be analyzed to determine burn depth and healing potential of a burn wound. Though IR thermography has great potential for burn wound assessment, its use for this has not been well documented. Thus, we have conducted a systematic review of the current use of IR thermography to assess burn depth and healing potential.

METHODS

A systematic review and meta-analysis of the literature was performed on PubMed and Google Scholar between June 2020-December 2020 using the following keywords: FLIR, FLIR ONE, thermography, forward looking infrared, thermal imaging + burn*, burn wound assessment, burn depth, burn wound depth, burn depth assessment, healing potential, burn healing potential. A meta-analysis was performed on the mean sensitivity and specificity of the ability of IR thermography for predicting healing potential. Inclusion criteria were articles investigating the use of IR thermography for burn wound assessments in adults and pediatric patients. Reviews and non-English articles were excluded.

RESULTS

A total of 19 articles were included in the final review. Statistically significant correlations were found between IR thermography and laser doppler imaging (LDI) in 4/4 clinical studies. A case report of a single patient found that IR thermography was more accurate than LDI for assessing burn depth. Five articles investigated the ability of IR thermography to predict healing time, with four reporting statistically significant results. Temperature differences between burnt and unburnt skin were found in 2/2 articles. IR thermography was compared to clinical assessment in five articles, with varying results regarding accuracy of clinical assessment compared to thermography. Mean sensitivity and specificity of the ability of IR thermography to determine healing potential <15 days was 44.5 and 98.8 respectively. Mean sensitivity and specificity of the ability of FLIR to determine healing potential <21 days was 51.2 and 77.9 respectively.

CONCLUSION

IR thermography is an accurate, simple, and cost-effective method of burn wound assessment. FLIR has been demonstrated to have significant correlations with other methods of assessing burns such as LDI and can be utilized to accurately assess burn depth and healing potential.

Functional Imaging in Wounds: Imaging Modalities of Today and Tomorrow

Wound care is a multidisciplinary field with significant economic burden to our healthcare system. Not only does wound care cost the US healthcare system $20 billion annually, but wounds also remarkably impact the quality of life of patients; wounds pose significant risk of mortality, as the five-year mortality rate for diabetic foot ulcers (DFUs) and ischemic ulcers is notably higher compared to commonly encountered cancers such as breast and prostate. Although it is important to measure how wounds may or may not be improving over time, the only relative "marker" for this is wound area measurement-area measurements can help providers determine if a wound is on a healing or non-healing trajectory. Because wound area measurements are currently the only readily available "gold standard" for predicting healing outcomes, there is a pressing need to understand how other relative biomarkers may play a role in wound healing. Currently, wound care centers across the nation employ various techniques to obtain wound area measurements; length and width of a wound can be measured with a ruler, but this carries a high amount of inter- and intrapersonal error as well as uncertainty. Acetate tracings could be used to limit the amount of error but do not account for depth, thereby making them inaccurate. Here, we discuss current imaging modalities and how they can serve to accurately measure wound size and serve as useful adjuncts in wound assessment. Moreover, new imaging modalities are also discussed and how up-and-coming technologies can provide important information on "biomarkers" for wound healing.

Thermal Imaging in a Clinically Non-assessable Free Flap Reconstruction of the Face

Free flap monitoring and early detection of malperfusion are a central aspect in reconstructive surgery. Warm ischemia, measured as the time a certain tissue is able to survive without any additional medical or thermal treatment, ranges from hours in muscle and nerval tissue up to days in bony tissue. Hence, meticulous flap monitoring is essential to discover early signs of malperfusion and decide upon timely re-intervention. Besides clinical examination techniques and Doppler sonography, a multitude of mostly experimental procedures are available to evaluate free flap perfusion. Particularly in older patients, the assessment of the skin island in microvascular grafts is a demanding task because the natural loss of elasticity, the reduction of subcutaneous tissue, and the decrease in water content limit the visibility of capillary filling and favor hematomas. We report a case of a 90-year-old woman with an extensive cutaneous squamous cell carcinoma of the right zygomatic and lateral orbital region without any locoregional or distant metastasis. Due to the resilient health status, we decided for a surgical approach with consecutive microvascular radial forearm flap reconstruction. On account of the difficult assessment of elderly skin after microvascular transplantation, we decided on additional flap monitoring by thermal heat imaging during the operation and aftercare. This case report discusses the successful application of thermal heat imaging in a clinical non-assessable free flap and discusses the application of dynamic infrared thermography as a monitoring tool in microvascular free flap surgery.

Antibacterial and safety tests of a flexible cold atmospheric plasma device for the stimulation of wound healing

Cold atmospheric plasma (CAP) devices generate an ionized gas with highly reactive species and electric fields at ambient air pressure and temperature. A flexible dielectric barrier discharge (DBD) was developed as an alternative antimicrobial treatment for chronic wounds. Treatment of Staphylococcus aureus in collagen-elastin matrices with CAP for 2 min resulted in a 4 log reduction. CAP treatment was less effective on S. aureus on dermal samples. CAP did not affect cellular activity or DNA integrity of human dermal samples when used for up to 2 min. Repeated daily CAP treatments for 2 min lowered cellular activity of dermal samples to 80% after 2 to 4 days, but this was not significant. Repeated treatment of ex vivo human burn wound models with CAP for 2 min did not affect re-epithelialization. Intact skin of 25 healthy volunteers was treated with CAP for 3× 20" to determine safety. Although participants reported moderate pain scores (numerical rating scale 3.3), all volunteers considered the procedure to be acceptable. Severe adverse events did not occur. CAP treatment resulted in a temporarily increased local skin temperature (≈3.4°C) and increased erythema. Lowering the plasma power resulted in a significantly lower erythema increase. Good log reduction (2.9) of bacterial load was reached in 14/15 volunteers artificially contaminated with Pseudomonas aeruginosa. This study demonstrated the in vitro and in vivo safety and efficacy in bacterial reduction of a flexible cold plasma device. Trial registration number NCT03007264, January 2, 2017 KEY POINTS: • CAP strongly reduced bacterial numbers both in vitro and in vivo. • Re-epithelialization of burn wound models was not affected by repeated CAP. • CAP treatment of intact skin was well tolerated in volunteers.

Mobile Smartphone Thermal Imaging Characterization and Identification of Microvascular Flow Insufficiencies in Deep Inferior Epigastric Artery Perforator Free Flaps

BACKGROUND

Mobile smartphone thermal imaging (MTI) devices correlate with blood flow, which makes them appealing adjuncts during reconstructive surgery. MTI was assessed in the setting of deep inferior epigastric artery perforator (DIEAP) free flaps. We hypothesized that MTI can be a surrogate for blood flow to identify microvascular flow insufficiencies.

METHODS

Nineteen patients underwent 30 DIEAP flaps for breast reconstruction. Images were obtained preoperatively, intraoperatively, and at instances of concern for flap viability. Three groups were evaluated: normal DIEAP flaps (NDFs), flaps with arterial insufficiency (AI), and flaps with venous congestion (VC).

RESULTS

All flaps were successful. There were significant temperature increases from max ischemia (24.5 ± 2.1°C) to 1 min after anastomosis (27.2 ± 1.6°C, P < 0.001). NDFs continued to warm until the final MTI was taken when leaving the operating room. There were no differences between MTI flap temperatures before transfer to the chest and after completion of microanastomosis. With questionable flap viability, VC and AI temperatures were found to be significantly colder than the NDF group (28.3 ± 1.9°C versus 32.2 ± 1.8°C, P = 0.003) in the VC group and (27.2 ± 0.7°C versus 32.2 ± 1.8°C, P = 0.001) in the AI group. After correction of the identified flow insufficiency, VC and AI rewarmed and temperatures were no different compared with NDF.

CONCLUSIONS

MTI recognizes microanastomotic failure and is a practical adjunct in the evaluation of free flap perfusion.

Indocyanine Green Angiography Predicts Tissue Necrosis More Accurately Than Thermal Imaging and Near-Infrared Spectroscopy in a Rat Perforator Flap Model

BACKGROUND

Clinical examination alone is neither sensitive nor specific for predicting flap necrosis, so several technologies, including indocyanine green angiography, thermal imaging (using the FLIR ONE), and near-infrared spectroscopy, have been developed to supplement perfusion assessment. This study aims to compare the accuracy of these three methods for intraoperatively predicting clinical flap necrosis in a rat perforator flap model. The authors hypothesized that near-infrared spectroscopy, assessing oxygenation rather than direct perfusion, would yield significantly different predictions.

METHODS

A 10 × 3-cm epigastric perforator flap was elevated in 14 adult male rats weighing 250 ± 50 g. Flap perfusion was assessed immediately after flap elevation using thermal imaging, near-infrared spectroscopy, and indocyanine green angiography. Measurements were correlated to the clinical endpoint and gold standard of flap necrosis on postoperative day 7.

RESULTS

All three technologies detected significant differences in perfusion along flap length (all p < 0.001), and were associated with significant differences in the odds of developing flap necrosis (all p < 0.001). The areas under the receiver operating characteristic curves were 0.948 for indocyanine green angiography as an absolute value, 0.873 for relative changes with thermal imaging, and 0.792 for tissue oxygenation. The sensitivity, specificity, and accuracy for indocyanine green angiography measured as an absolute value were the highest at 97.8, 87.5, and 92 percent, respectively.

CONCLUSIONS

Indocyanine green angiography most accurately predicted flap necrosis in this study; however, tissue oximetry and thermal imaging were also capable of predicting necrosis and represented potentially less expensive or more readily available alternatives for objective perfusion assessment. Additional research can further delineate their roles and cost-efficacy in clinical practice.

A Cost-Effective System for Aerial 3D Thermography of Buildings

Three-dimensional (3D) imaging and infrared (IR) thermography are powerful tools in many areas in engineering and sciences. Their joint use is of great interest in the buildings sector, allowing inspection and non-destructive testing of elements as well as an evaluation of the energy efficiency. When dealing with large and complex structures, as buildings (particularly historical) generally are, 3D thermography inspection is enhanced by Unmanned Aerial Vehicles (UAV—also known as drones). The aim of this paper is to propose a simple and cost-effective system for aerial 3D thermography of buildings. Special attention is thus payed to instrument and reconstruction software choice. After a very brief introduction to IR thermography for buildings and 3D thermography, the system is described. Some experimental results are given to validate the proposal.

Influence of power and maximal strength training on thermal reaction and vertical jump performance in Brazilian basketball players: a preliminary study

Study aim: To evaluate the effect of power and muscle strength training on skin temperature and the performance of the vertical jump with countermovement (CMJ).

Material and methods: The sample consisted of four male basketball athletes of the under-17 category (age: 15.75 ± 1.0 years). 48 hours after anthropometric evaluation and determination of the loads for 1 repetition maximum (1RM) in the leg extension exercise, the athletes were subjected, through crossover-type entrance, to power (PTP) and strength (STP) training protocols. The protocols consisted of three sets with loads of 60% and 90% of 1RM for PTP and STP, respectively. Thermographic images of the thighs were taken before and immediately after each training session.

Results: There were significant differences in results between the two training protocols, with increased total repetitions (t = 13.481; p < 0.05) and total training volume (t = 15.944; p < 0.05) in the PTP, and increase in the % of 1RM (t = 33.903; p < 0.05) and rating of perceived exertion (t = 6.755; p < 0.05) in the STP. The skin temperature before and after PTP and STP showed no significant differences. In the post-STP, the CMJ presented significant reductions in height (t = 3.318; p < 0.05), flight time (t = 3.620; p < 0.05), velocity (t = 3.502; p < 0.05), and force (t = 4.381; p < 0.05). There were no significant differences in pre-and post-STP CMJ.

Conclusions: Power and maximum strength training in the leg extension exercise performed until concentric failure appears to be a method that induces thermal stress on the skin. This training directly influenced the performance of the vertical jump after the stimulus.

A prospective study comparing the FLIR ONE with laser Doppler imaging in the assessment of burn depth by a tertiary burns unit in the United Kingdom

INTRODUCTION

Laser Doppler imaging (LDI) is the 'gold standard' tool for the assessment of burn depth. However, it is costly. The FLIR ONE is a novel, mobile-attached, thermal imaging camera used to assess burn wound temperature. This study compares the FLIR ONE and LDI in assessing burn depth and predicting healing times.

METHODS

Forty-five adult patients with burn wounds, presenting at 1-5 days, were imaged with the FLIR ONE and LDI. Infected, chemical and electrical burns were excluded. Healing potential was determined by comparing wound and normal skin temperature for the FLIR ONE and blood flow changes with the LDI. Healing potential was categorised into wounds healing in less than and over 21 days. Pearson's test was used to determine the correlation between changes in wound temperature and healing potential.

RESULTS

Percent total body surface area (%TBSA) was in the range of 0.5-45. FLIR demonstrated a sensitivity of 66.67% and specificity of 76.67% in predicting healing within 21 days, while LDI demonstrated a sensitivity of 93.33% and specificity of 40%. The FLIR ONE showed a significant difference in the mean temperature changes between burns that healed in less than (0.1933 ± 0.3554) and over 21 days (-1 ± 0.4329) (P = 0.04904). Pearson's test showed a significant correlation between the difference in wound and normal skin temperature with healing times (P = 0.04517).

CONCLUSION

The inexpensive FLIR ONE shows a significant correlation between changes in wound temperature and healing times. It is useful in predicting healing within 21 days. However, evaporative cooling at the wound surface can lead to overprediction of healing times and overtreatment.

LAY SUMMARY

Background Laser Doppler imaging is currently the main tool for burn depth assessment. It works by analysing the blood flow in a burn wound. Based on these findings, it can predict the depth of the burn injury and predict if it will heal in less than or over 21 days. The main problem is that it is costly. The FLIR ONE is a novel, mobile-attached, thermal imaging camera. It can be used to assess burn depth by comparing the temperature of the burn wound to the surrounding normal skin. This information can then be used to predict healing times into less than and over 21 days. The issue being explored The usefulness of the FLIR ONE in assessing burn depth and predicting healing time when compared to the LDI. How was the work conducted? Forty-five adult patients who sustained a burn injury within the last five days were imaged with both the FLIR ONE and LDI. Those with infected, electrical or chemical burns were excluded. Healing potential was determined by comparing the temperature of the burn wound with normal skin for the FLIR ONE and by changes in wound blood flow with the LDI. Healing potential was categorised into wounds healing in less than and over 21 days. The correlation between the temperature changes of the burn wound and healing time was evaluated for the FLIR ONE. What we learned from the study This study was able to demonstrate that the FLIR ONE showed a significant correlation between the temperature difference between the burn wound and normal skin with healing times. When compared with the LDI, the FLIR ONE was useful in predicting if a burn wound will heal in less than 21 days. The FLIR ONE has advantages over the LDI, it is low cost, portable and produces instantaneous images. Ultimately, this developing technology may increase access to higher standard burn care in centres where LDI is not affordable.

Validity of thermography for measuring burn wound healing potential

Accurate assessment of burn wound depth and the associated healing potential is vital in determining the need for surgical treatment in burns. Infrared thermography measures the temperature of the burn wound noninvasively, thereby providing indirect information on its blood flow. Previous research demonstrated that a small, low‐priced, handheld thermal imager has an excellent reliability, but a moderate validity for measuring burn wound healing potential. A new and more sensitive version of this convenient device has become available. The aim of this study was to evaluate the validity of thermography for measuring burn wound healing potential, compared to Laser Doppler Imaging (LDI) as a reference standard. Thermal images and LDI scans were obtained from burn wounds between 2 and 5 days postburn. Temperature differences between burned and nonburned skin (ΔT) were calculated. To evaluate validity, ΔT values were compared to the healing potential categories assessed by LDI. Two receiver operating characteristic curves were created and two ΔT cutoff values were calculated to illustrate the ability to discriminate between burn wounds that heal in a time period of less than 14 days, between 14 and 21 days, and more than 21 days. Between June and October 2018, 43 burn wounds in 32 patients were measured. ΔT cutoff values of 0.6°C (sensitivity 68%, specificity 95%) and −2.3°C (sensitivity 30%, specificity 95%) were calculated to discriminate between burn wounds that heal in <14 and ≥14 days, and burn wound that heal in ≤21 and >21 days, respectively. This study shows a good validity of the feasible thermal imager for the assessment of burn wound healing potential. Therefore, we consider it a promising technique to be used for triage in local hospitals and general practices, and as a valuable addition to clinical evaluation in burn centers.

Smartphone-Based Device in Exotic Pet Medicine

This article reviews the use of the smartphone in exotic pet medicine. The mobile app is the most instinctive use of the smartphone; however, there are very limited software dedicated to the exotic pet specifically. With an adapter, the smartphone can be attached to a regular endoscope and acts as a small endoscopic unit. Additional devices, such as infrared thermography or ultrasound, can be connected to the smartphone through the micro-USB port. The medical use of the smartphone is still in its infancy in veterinary medicine but can bring several solutions to the exotic pet practitioner and improve point-of-care evaluation.

ThermalWrist: Smartphone Thermal Camera Correction Using a Wristband Sensor †

Thermal images are widely used for various healthcare applications and advanced research. However, thermal images captured by smartphone thermal cameras are not accurate for monitoring human body temperature due to the small body that is vulnerable to temperature change. In this paper, we propose ThermalWrist, a dynamic offset correction method for thermal images captured by smartphone thermal cameras. We fully utilize the characteristic that is specific to thermal cameras: the relative temperatures in a single thermal image are highly reliable, although the absolute temperatures fluctuate frequently. To correct the offset error, ThermalWrist combines thermal images with a reliable absolute temperature obtained by a wristband sensor based on the above characteristic. The evaluation results in an indoor air-conditioned environment shows that the mean absolute error and the standard deviation of face temperature measurement error decrease by 49.4% and 64.9%, respectively. In addition, Pearson’s correlation coefficient increases by 112%, highlighting the effectiveness of ThermalWrist. We also investigate the limitation with respect to the ambient temperature where ThermalWrist works effectively. The result shows ThermalWrist works well in the normal office environment, which is 22.91 °C and above.

The Utility of Smartphone Applications and Technology in Wound Healing

Appropriate management of both acute and chronic wounds is a dynamic practice that consumes large amounts of time and financial resources within the health care system. Traditionally, wounds were measured clinically and subjectively, leading to inaccuracies in assessing wound progression and healing over time. The recent development of mobile applications and digital equipment in medicine provides an opportunity for significant improvement in wound care through the incorporation of “smart” technologies in clinical practice. The utility of these technologies has been assessed regarding the treatment of diabetic foot ulcers, burns, and general wounds. The focus of this review is to provide an update on the current status of mobile applications and digital technology in the management of wounds.