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Madian IM, Sherif WI, El Fahar MH, Othman WN. The use of smartphone thermography to evaluate wound healing in second-degree burns. Burns 2025; 51:107307. [PMID: 39933420 DOI: 10.1016/j.burns.2024.107307] [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: 11/05/2023] [Revised: 10/05/2024] [Accepted: 11/02/2024] [Indexed: 02/13/2025]
Abstract
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.
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Affiliation(s)
- Islam M Madian
- Clinical Instructor at Plastic, Reconstructive and Burn Surgery Center at Mansoura University Hospitals, Egypt
| | - Wafaa I Sherif
- Professor of Medical-Surgical Nursing Department, Faculty of Nursing, Mansoura University, Egypt
| | - Mohammed H El Fahar
- Professor of Plastic and Reconstructive Surgery, Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Mansoura University, Egypt.
| | - Walaa N Othman
- Professor of Medical-Surgical Nursing Department, Faculty of Nursing, Mansoura University, Egypt
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2
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Nascimento Júnior JAC, Oliveira AMS, Porras KDL, Menezes PDP, Araujo AADS, Nunes PS, Aragón DM, Serafini MR. Exploring trends in natural product-based treatments to skin burn: A comprehensive review. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2025; 139:156481. [PMID: 39951972 DOI: 10.1016/j.phymed.2025.156481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2024] [Revised: 01/13/2025] [Accepted: 02/05/2025] [Indexed: 02/17/2025]
Abstract
BACKGROUND Burns are traumatic injuries caused by thermal, chemical, or other external factor, significantly impacting organic tissue. They are among the most common and severe types of trauma worldwide, often resulting in considerable morbidity and mortality. Natural products, owing to their pharmacological properties, present promising avenues for burn management and treatment. PURPOSE This study aims to provide a comprehensive review of patented pharmaceutical formulations containing natural products for burn treatment and to define trends in the market. METHODS Patent documents were identified through searches in the World Intellectual Property Organization (WIPO) and European Patent Office (EPO) databases using "burn*" as a keyword in the title and/or abstract and International Patent Classification (IPC) code A61K36/00. The review also examines clinical trials and SWOT analyses to evaluate strengths, weaknesses, opportunities, and threats in this field. RESULTS A total of 82 patents were selected, highlighting the use of natural products, such as Aloe vera, Coptis chinensis, borneol, menthol, and propolis, predominantly derived from Traditional Chinese Medicine. These findings are supplemented with clinical trial data and market insights. The results underscore both the therapeutic efficacy and challenges, such as standardization and regulatory hurdles, of using natural products. CONCLUSION This patent review highlights the potential of natural-origin formulations in addressing the limitations of conventional burn treatments. Continued research is essential to overcome existing barriers, ensuring broader accessibility and enhanced therapeutic outcomes.
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Affiliation(s)
| | - Ana Maria Santos Oliveira
- Postgraduate Program in Pharmaceutical Sciences, Federal University of Sergipe, São Cristóvão, Brazil
| | | | - Paula Dos Passos Menezes
- Postgraduate Program in Health Sciences, Federal University of Sergipe, São Cristóvão, Brazil; SejaPhD, Brazil
| | - Adriano Antunes de Souza Araujo
- Postgraduate Program in Pharmaceutical Sciences, Federal University of Sergipe, São Cristóvão, Brazil; Postgraduate Program in Health Sciences, Federal University of Sergipe, São Cristóvão, Brazil
| | - Paula Santos Nunes
- Postgraduate Program in Health Sciences, Federal University of Sergipe, São Cristóvão, Brazil
| | - Diana Marcela Aragón
- Departamento de Farmacia, Facultad de Ciencias, Universidad Nacional da Colombia, Bogotá D.C., Colombia
| | - Mairim Russo Serafini
- Postgraduate Program in Pharmaceutical Sciences, Federal University of Sergipe, São Cristóvão, Brazil; Postgraduate Program in Health Sciences, Federal University of Sergipe, São Cristóvão, Brazil.
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3
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Cretu A, Grosu-Bularda A, Bordeanu-Diaconescu EM, Hodea FV, Ratoiu VA, Dumitru CS, Andrei MC, Neagu TP, Lascar I, Hariga CS. Strategies for Optimizing Acute Burn Wound Therapy: A Comprehensive Review. MEDICINA (KAUNAS, LITHUANIA) 2025; 61:128. [PMID: 39859110 PMCID: PMC11766551 DOI: 10.3390/medicina61010128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2024] [Revised: 01/04/2025] [Accepted: 01/13/2025] [Indexed: 01/27/2025]
Abstract
Recent advancements in acute burn wound therapy are transforming the management of burn injuries, with a focus on improving healing times, graft integration, and minimizing complications. However, current clinical treatments face significant challenges, including the difficulty of accurately assessing wound depth and tissue viability, which can lead to suboptimal treatment planning. Traditional closure methods often struggle with issues such as delayed wound closure, limited graft survival, inadequate tissue regeneration, and insufficient vascularization. Furthermore, managing infection and minimizing scarring remain persistent obstacles, impacting functional recovery and aesthetic outcomes. Key areas of innovation include advanced imaging techniques that enable more precise assessment of wound depth, size, and tissue viability, allowing for more accurate treatment planning. In addition, new closure strategies are being developed to accelerate wound closure, enhance graft survival, and address challenges such as tissue regeneration, vascularization, and infection prevention. These strategies aim to optimize both functional recovery and aesthetic outcomes, reducing scarring and improving the quality of life for burn patients. While promising, these emerging techniques require further research and clinical validation to refine their effectiveness and expand their accessibility. Together, these innovations represent a significant shift in acute burn care, offering the potential for more personalized, efficient, and effective treatments.
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Affiliation(s)
- Andrei Cretu
- Department 11, Discipline Plastic and Reconstructive Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.C.)
- Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
| | - Andreea Grosu-Bularda
- Department 11, Discipline Plastic and Reconstructive Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.C.)
- Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
| | - Eliza-Maria Bordeanu-Diaconescu
- Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
| | - Florin-Vlad Hodea
- Department 11, Discipline Plastic and Reconstructive Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.C.)
- Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
| | - Vladut-Alin Ratoiu
- Department 11, Discipline Plastic and Reconstructive Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.C.)
- Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
| | - Catalina-Stefania Dumitru
- Department 11, Discipline Plastic and Reconstructive Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.C.)
- Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
| | - Mihaela-Cristina Andrei
- Department 11, Discipline Plastic and Reconstructive Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.C.)
- Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
| | - Tiberiu-Paul Neagu
- Department 11, Discipline Plastic and Reconstructive Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.C.)
- Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
| | - Ioan Lascar
- Department 11, Discipline Plastic and Reconstructive Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.C.)
- Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
| | - Cristian-Sorin Hariga
- Department 11, Discipline Plastic and Reconstructive Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.C.)
- Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
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Ceccaroni A, Cuomo R, Pentangelo P, Gentile A, Marra C, Rozen WM, Seth I, Lim B, Alfano C. Exploring Reverse Sural Flap Necrosis in Lupus-like Syndrome: Challenges and Strategies in Lower Limb Reconstruction-A Case Presentation. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:2053. [PMID: 39768932 PMCID: PMC11678630 DOI: 10.3390/medicina60122053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2024] [Revised: 10/30/2024] [Accepted: 11/27/2024] [Indexed: 01/11/2025]
Abstract
Soft tissue reconstruction in the lower limbs presents a significant challenge, particularly when addressing defects in the distal third of the leg, ankle, and foot. The reverse sural flap reliant on the perforating branches of the peroneal artery has emerged as a versatile option, offering a solution for patients for whom microsurgical techniques are not feasible. Despite its advantages, the procedure carries inherent risks, especially in populations with underlying conditions, such as venous insufficiency, cardiovascular disease, and diabetes, as well as in elderly patients, where the likelihood of flap necrosis is elevated. This report details a case of reverse sural flap necrosis in a patient with lupus-like syndrome, a complex scenario that underscores the need for meticulous preoperative assessment and planning. The case illustrates not only the technical considerations and challenges associated with the reverse sural flap but also the broader implications of systemic autoimmune disorders on postoperative outcomes. Through a comprehensive review of the literature, we explore the relationship between vascularization, autoimmune profiles, and the success of reverse sural flap procedures. We highlight the critical need for surgeons to adopt a holistic approach to patient evaluation, considering both local and systemic factors that may influence the viability of the flap and the overall reconstructive success.
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Affiliation(s)
- Alessandra Ceccaroni
- Plastic Surgery Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, 84081 Salerno, Italy; (P.P.); (A.G.); (C.M.); (C.A.)
| | - Roberto Cuomo
- Plastic and Reconstructive Surgery Division, Department of Medicine, Surgery and Neuroscience, Santa Maria alle Scotte Hospital, University of Siena, 53100 Siena, Italy;
| | - Paola Pentangelo
- Plastic Surgery Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, 84081 Salerno, Italy; (P.P.); (A.G.); (C.M.); (C.A.)
| | - Antonioenrico Gentile
- Plastic Surgery Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, 84081 Salerno, Italy; (P.P.); (A.G.); (C.M.); (C.A.)
| | - Caterina Marra
- Plastic Surgery Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, 84081 Salerno, Italy; (P.P.); (A.G.); (C.M.); (C.A.)
| | - Warren Matthew Rozen
- Department of Plastic Surgery, Peninsula Health, Melbourne, VIC 3199, Australia; (W.M.R.); (I.S.); (B.L.)
| | - Ishith Seth
- Department of Plastic Surgery, Peninsula Health, Melbourne, VIC 3199, Australia; (W.M.R.); (I.S.); (B.L.)
| | - Bryan Lim
- Department of Plastic Surgery, Peninsula Health, Melbourne, VIC 3199, Australia; (W.M.R.); (I.S.); (B.L.)
| | - Carmine Alfano
- Plastic Surgery Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, 84081 Salerno, Italy; (P.P.); (A.G.); (C.M.); (C.A.)
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Fridberg M, Bafor A, Iobst CA, Laugesen B, Jepsen JF, Rahbek O, Kold S. The role of thermography in assessment of wounds. A scoping review. Injury 2024; 55:111833. [PMID: 39226731 DOI: 10.1016/j.injury.2024.111833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 08/09/2024] [Accepted: 08/18/2024] [Indexed: 09/05/2024]
Abstract
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.
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Affiliation(s)
- Marie Fridberg
- Interdisciplinary Orthopaedics, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark.
| | - Anirejuoritse Bafor
- Center for Limb Lengthening and Reconstruction, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
| | - Christopher A Iobst
- Center for Limb Lengthening and Reconstruction, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
| | - Britt Laugesen
- Clinical Nursing Research Unit, Aalborg University Hospital & Center for Clinical Guidelines, Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, 9000 Aalborg, Denmark.
| | - Jette Frost Jepsen
- Medical Library, Aalborg University, Sdr. Skovvej 15, Forskningens Hus, 9000 Aalborg, Denmark.
| | - Ole Rahbek
- Interdisciplinary Orthopaedics, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark.
| | - Søren Kold
- Interdisciplinary Orthopaedics, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark.
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Xu J, Zhu M, Tang P, Li J, Gao K, Qiu H, Zhao S, Lan G, Jia H, Yu B. Visualization enhancement by PCA-based image fusion for skin burns assessment in polarization-sensitive OCT. BIOMEDICAL OPTICS EXPRESS 2024; 15:4190-4205. [PMID: 39022536 PMCID: PMC11249677 DOI: 10.1364/boe.521399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 05/31/2024] [Accepted: 06/01/2024] [Indexed: 07/20/2024]
Abstract
Polarization-sensitive optical coherence tomography (PS-OCT) is a functional imaging tool for measuring tissue birefringence characteristics. It has been proposed as a potentially non-invasive technique for evaluating skin burns. However, the PS-OCT modality usually suffers from high system complexity and relatively low tissue-specific contrast, which makes assessing the extent of burns in skin tissue difficult. In this study, we employ an all-fiber-based PS-OCT system with single-state input, which is simple and efficient for skin burn assessment. Multiple parameters, such as phase retardation (PR), degree of polarization uniformity (DOPU), and optical axis orientation, are obtained to extract birefringent features, which are sensitive to subtle changes in structural arrangement and tissue composition. Experiments on ex vivo porcine skins burned at different temperatures were conducted for skin burn investigation. The burned depths estimated by PR and DOPU increase linearly with the burn temperature to a certain extent, which is helpful in classifying skin burn degrees. We also propose an algorithm of image fusion based on principal component analysis (PCA) to enhance tissue contrast for the multi-parameter data of PS-OCT imaging. The results show that the enhanced images generated by the PCA-based image fusion method have higher tissue contrast, compared to the en-face polarization images by traditional mean value projection. The proposed approaches in this study make it possible to assess skin burn severity and distinguish between burned and normal tissues.
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Affiliation(s)
- Jingjiang Xu
- Guangdong-Hong Kong-Macao Intelligent Micro-Nano Optoelectronic Technology Joint Laboratory, Foshan University
, Foshan, Guangdong 528000, China
- Innovation and Entrepreneurship Teams Project of Guangdong Pearl River Talents Program, Guangdong Weiren Meditech Co., Ltd., Foshan, Guangdong 528051, China
| | - Mingtao Zhu
- School of Mechatronic Engineering and Automation, Foshan University, Foshan, Guangdong 528000, China
| | - Peijun Tang
- College of Biophotonics, South China Normal University, Guangzhou 510006, China
| | - Junyun Li
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Kai Gao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
| | - Haixia Qiu
- Department of Laser Medicine, the First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China
| | - Shiyong Zhao
- Tianjin Hengyu Medical Technology Co., Ltd., Tianjin 300000, China
| | - Gongpu Lan
- Guangdong-Hong Kong-Macao Intelligent Micro-Nano Optoelectronic Technology Joint Laboratory, Foshan University
, Foshan, Guangdong 528000, China
- Innovation and Entrepreneurship Teams Project of Guangdong Pearl River Talents Program, Guangdong Weiren Meditech Co., Ltd., Foshan, Guangdong 528051, China
| | - Haibo Jia
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, China
| | - Bo Yu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, China
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Wu J, Ma Q, Zhou X, Wei Y, Liu Z, Kang H. Segmentation and quantitative analysis of optical coherence tomography (OCT) images of laser burned skin based on deep learning. Biomed Phys Eng Express 2024; 10:045026. [PMID: 38718764 DOI: 10.1088/2057-1976/ad488f] [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: 02/28/2024] [Accepted: 05/08/2024] [Indexed: 05/22/2024]
Abstract
Evaluation of skin recovery is an important step in the treatment of burns. However, conventional methods only observe the surface of the skin and cannot quantify the injury volume. Optical coherence tomography (OCT) is a non-invasive, non-contact, real-time technique. Swept source OCT uses near infrared light and analyzes the intensity of light echo at different depths to generate images from optical interference signals. To quantify the dynamic recovery of skin burns over time, laser induced skin burns in mice were evaluated using deep learning of Swept source OCT images. A laser-induced mouse skin thermal injury model was established in thirty Kunming mice, and OCT images of normal and burned areas of mouse skin were acquired at day 0, day 1, day 3, day 7, and day 14 after laser irradiation. This resulted in 7000 normal and 1400 burn B-scan images which were divided into training, validation, and test sets at 8:1.5:0.5 ratio for the normal data and 8:1:1 for the burn data. Normal images were manually annotated, and the deep learning U-Net model (verified with PSPNe and HRNet models) was used to segment the skin into three layers: the dermal epidermal layer, subcutaneous fat layer, and muscle layer. For the burn images, the models were trained to segment just the damaged area. Three-dimensional reconstruction technology was then used to reconstruct the damaged tissue and calculate the damaged tissue volume. The average IoU value and f-score of the normal tissue layer U-Net segmentation model were 0.876 and 0.934 respectively. The IoU value of the burn area segmentation model reached 0.907 and f-score value reached 0.951. Compared with manual labeling, the U-Net model was faster with higher accuracy for skin stratification. OCT and U-Net segmentation can provide rapid and accurate analysis of tissue changes and clinical guidance in the treatment of burns.
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Affiliation(s)
- Jingyuan Wu
- Beijing Institute of Radiation Medicine, Beijing 100850, People's Republic of China
- College of Life Sciences, Hebei University, Baoding, Hebei 071002, People's Republic of China
| | - Qiong Ma
- Beijing Institute of Radiation Medicine, Beijing 100850, People's Republic of China
| | - Xun Zhou
- Beijing Institute of Radiation Medicine, Beijing 100850, People's Republic of China
| | - Yu Wei
- Beijing Institute of Radiation Medicine, Beijing 100850, People's Republic of China
- College of Life Sciences, Hebei University, Baoding, Hebei 071002, People's Republic of China
| | - Zhibo Liu
- Beijing Institute of Radiation Medicine, Beijing 100850, People's Republic of China
| | - Hongxiang Kang
- Beijing Institute of Radiation Medicine, Beijing 100850, People's Republic of China
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de Haan J, Stoop M, van Zuijlen PPM, Pijpe A. Thermal Imaging for Burn Wound Depth Assessment: A Mixed-Methods Implementation Study. J Clin Med 2024; 13:2061. [PMID: 38610828 PMCID: PMC11012455 DOI: 10.3390/jcm13072061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 03/25/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
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.
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Affiliation(s)
- Jesse de Haan
- Burn Center, Red Cross Hospital, Vondellaan 13, 1942 LE Beverwijk, The Netherlands; (J.d.H.); or (M.S.); or (P.P.M.v.Z.)
| | - Matthea Stoop
- Burn Center, Red Cross Hospital, Vondellaan 13, 1942 LE Beverwijk, The Netherlands; (J.d.H.); or (M.S.); or (P.P.M.v.Z.)
- Plastic, Reconstructive and Hand Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Association of Dutch Burn Centers, 1941 AJ Beverwijk, The Netherlands
| | - Paul P. M. van Zuijlen
- Burn Center, Red Cross Hospital, Vondellaan 13, 1942 LE Beverwijk, The Netherlands; (J.d.H.); or (M.S.); or (P.P.M.v.Z.)
- Plastic, Reconstructive and Hand Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Paediatric Surgical Center, Emma Children’s Hospital, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Vondellaan 13, 1942 LE Beverwijk, The Netherlands
- Amsterdam Movement Sciences, Tissue Function and Regeneration, 1081 HV Amsterdam, The Netherlands
| | - Anouk Pijpe
- Burn Center, Red Cross Hospital, Vondellaan 13, 1942 LE Beverwijk, The Netherlands; (J.d.H.); or (M.S.); or (P.P.M.v.Z.)
- Plastic, Reconstructive and Hand Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Association of Dutch Burn Centers, 1941 AJ Beverwijk, The Netherlands
- Amsterdam Movement Sciences, Tissue Function and Regeneration, 1081 HV Amsterdam, The Netherlands
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Leon-Villapalos J, Barret JP. Surgical Repair of the Acute Burn Wound: Who, When, What Techniques? What Is the Future? J Burn Care Res 2023; 44:S5-S12. [PMID: 36567475 DOI: 10.1093/jbcr/irac145] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Modern burns surgery is multidisciplinary, multimodal and includes a dermal preservation approach. The management of the surgical wound starts in the pre-hospital environment with stabilization and assessment of the burn injured patient according to protocols of trauma resuscitation with special emphasis in the assessment of the burn depth and surface area. A large burn requires fluid resuscitation and physiological support, including counterbalancing hyper metabolism, fighting infection and starting a long burns intensive care journey. A deep burn may impose the need for surgical debridement and cover through a staged approach of excision of devitalized tissue depending on its extension and patient circumstances. These methodologies warrant patients survivability and require professionals integrated in a multidisciplinary team sharing decisions and directing management. Burns Multimodality involves multiple techniques used according to patient's needs, wound environment, operators experience and available resources. Traditional practices used together with new techniques may reduce morbidity and operative time but also challenge stablished practice. The concept of using the best teams with the best techniques combines with the need for selective and judicious surgery that preserves tissue architecture and spares as much as possible dermal component, therefore reducing the possibility of functional impairment and cosmetic embarrassment caused by pathological scars. Who is best placed to perform these tasks, the appropriate or best timing of surgery and the different practices used to achieve best results will be discussed, together with a reflection on what the future holds for these fundamental steps in the management of the burn injured patient turning into a functional burn survivor.
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Affiliation(s)
- Jorge Leon-Villapalos
- Consultant Plastic, Reconstructive, Laser and Burns Surgeon, Plastic Surgery and Burns Department, Chelsea and Westminster Hospital, London, UK.,BAPRAS Burns Special Interest and Advisory Group, London, UK.,Senior Honorary Clinical Lecturer, Imperial College School of Medicine, London, UK
| | - Juan P Barret
- Department of Plastic Surgery and Burns, Vall d'Hebron Barcelona Hospital Campus, Universidad Autònoma de Barcelona, Barcelona, Spain
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The Value of Infrared Thermography to Assess Foot and Limb Perfusion in Relation to Medical, Surgical, Exercise or Pharmacological Interventions in Peripheral Artery Disease: A Systematic Review. Diagnostics (Basel) 2022; 12:diagnostics12123007. [PMID: 36553014 PMCID: PMC9777328 DOI: 10.3390/diagnostics12123007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/11/2022] [Accepted: 11/25/2022] [Indexed: 12/05/2022] Open
Abstract
Infrared thermography (IRT) is a promising imaging method in patients with peripheral artery disease (PAD). This systematic review aims to provide an up-to-date overview of the employment of IRT as both a diagnostic method and an outcome measure in PAD patients in relation to any kind of intervention. On September 2022, MEDLINE, EMBASE, CENTRAL, Google Scholar, Web of Science, and gray literature were screened. Eligible articles employing IRT in PAD were screened for possible inclusion. The RoB 2.0 tool was used to assess the risk of bias. Twenty-one eligible articles were finally included, recruiting a total of 1078 patients. The IRT was used for PAD diagnosis/monitoring in 11 studies or to assess the effect of interventions (revascularization, pharmacological therapy, or exercise rehabilitation) in 10 studies. The analysis of the included papers raised high concerns about the overall quality of the studies. In conclusion, IRT as a noninvasive technique showed promising results in detecting foot perfusion in PAD patients. However, limits related to devices, points of reference, and measurement conditions need to be overcome by properly designed trials before recommending its implementation in current vascular practice.
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11
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Ishak A, Jusuf AA, Simadibrata CL, Barasila AC, Novita R. Effect of Manual Acupuncture and Laser Acupuncture on Wound Closure in Rat with Deep Partial Thickness Burn Injury. Med Acupunct 2022; 34:240-250. [PMID: 36051408 PMCID: PMC9419944 DOI: 10.1089/acu.2021.0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Burns are defined as tissue damage that occurs as a result of the action of heat. Although many advanced treatments have been made in burn therapy, slow wound healing remains a challenge in burn treatment. Acupuncture can accelerate burn healing through its anti-inflammatory effect, increasing re-epithelialization and angiogenesis. Objectives This study assessed the effect of manual acupuncture and laser acupuncture on the healing of burns that were observed macroscopically and microscopically. Methods Thirty-six male Wistar rats with deep partial thickness burns were randomly divided into control group (n = 12), acupuncture group (n = 12), and laser acupuncture group (n = 12). Wound measurements and treatments were given every 2 days for 14 days. Results On the 14th day of macroscopic evaluations, there was a significant difference (P = 0.009) between the acupuncture group (66.96 ± 9.17) and the control group (49.93 ± 9.15), and a significant difference (P = 0.009) between laser acupuncture group (72.48 ± 14.62) and the control group. However, there was no significant difference (P = 0.451) between acupuncture and laser acupuncture groups. On the 14th day of microscopic evaluations, there was a significant difference (P < 0.001) between the acupuncture group (16.17 ± 1.17) and the control group (10.33 ± 1.21), and a significant difference (P = 0.004) between the laser acupuncture group (17.83 ± 1.47) and the control group. However, there was no significant difference (P = 0.058) between acupuncture and laser acupuncture groups. Conclusion The results showed that either acupuncture therapy or laser acupuncture therapy could be used as an adjunct therapy to accelerate burn healing.
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Affiliation(s)
- Andy Ishak
- Medical Acupuncture Specialist Program, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Ahmad Aulia Jusuf
- Department of Histology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | | | | | - Risqa Novita
- Centre of Biomedical and Basic Health Technology, NIHRD, Jakarta, Indonesia
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Wijers CDM, Stark RJ. Case report: Temporal alterations in vascular function during the first 2 weeks of pediatric septic shock. Front Pediatr 2022; 10:939886. [PMID: 35935367 PMCID: PMC9354618 DOI: 10.3389/fped.2022.939886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/30/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION During sepsis and septic shock, the host's immune systems generate an overwhelming and often, detrimental, inflammatory response. Part of this response results in significant alterations in blood flow and vasomotor tone regulated in part by endothelial and vascular smooth muscle cells. Here, we report on a series of 3 pediatric patients for whom vascular response was assessed by laser doppler perfusion coupled to iontophoresis over the first 2 weeks after hospitalization for septic shock to demonstrate similarities and dissimilarities in the vascular response. CASE PRESENTATIONS A 12-year-old male with a history of Burkitt's Lymphoma, a 21-year-old male with congenital porencephaly and epilepsy, and a 7-year-old male with no significant past medical history all were admitted to a tertiary care children's hospital with a diagnosis of septic shock requiring vasoactive infusions to maintain mean arterial blood pressure. Non-invasive laser doppler perfusion coupled with iontophoresis of either acetylcholine (endothelial-dependent response) or sodium nitroprusside (endothelial-independent response) was performed on hospital days 1, 3, 7, and 14. Variability and heterogeneity were demonstrated by the temporal assessments of the vascular response to sodium nitroprusside, but all three patients showed significant similarity in the temporal responsiveness to acetylcholine. CONCLUSION Assessment of baseline and temporal responsiveness to endothelial-dependent vascular reactivity may provide a predictable timeline to the resolution of pediatric septic shock.
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Affiliation(s)
| | - Ryan J Stark
- Department of Pediatric Critical Care, Vanderbilt University Medical Center, Nashville, TN, United States
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Han T, Sun B, Wang W, Cui J, Shen W. The Role of ICG Angiography in Decision Making About Skin-Sparing in Pediatric Acute Trauma. Front Pediatr 2022; 10:851270. [PMID: 35372153 PMCID: PMC8967320 DOI: 10.3389/fped.2022.851270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 02/01/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Indocyanine green (ICG) angiography has proven useful in assessing skin flap perfusion in plastic and reconstructive surgeries. This research aimed to explore its role in decision making about skin-sparing in children's acute trauma. METHODS A total of 19 patients suffering with acute trauma from January 2019 to September 2021 were retrospectively assessed. Both ICG angiography and clinical judgment were performed to evaluate skin tissue viability. The intraoperative decisions for each case depended on the specific condition of the traumatic wound, including tissue perfusion, skin defect area, and location of the wound. Postoperative vascular imaging software was used to quantify the tissue perfusion, and the duration of postoperative follow-up was from 6 to 18 months. RESULTS Among them, 18 (94.7%) patients experienced treatments according to ICG angiography and did not develop postoperative necrosis. One case with right forearm trauma suffered from partial necrosis. Hypertrophic scar and local infection were the independent complications, which were managed by symptomatic treatment. CONCLUSION ICG angiography may reduce the risk of postoperative necrosis and renders a promising adjunctive technique for surgeons to make reasonable decisions in skin sparing in acute pediatric trauma.
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Affiliation(s)
- Tao Han
- Department of Burns and Plastic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Buhao Sun
- Department of Burns and Plastic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Weidong Wang
- Department of Burns and Plastic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Jie Cui
- Department of Burns and Plastic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Weimin Shen
- Department of Burns and Plastic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
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