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Khong P, Yeo M, Goh C. Evaluating an iPad app in measuring wound dimension: a pilot study. J Wound Care 2017; 26:752-760. [DOI: 10.12968/jowc.2017.26.12.752] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- P.C.B. Khong
- Senior Nurse Manager, Tan Tock Seng Hospital Pte Ltd, 11 Jalan Tan Tock Seng, Singapore 308433
| | - M.S.W. Yeo
- Consultant, Tan Tock Seng Hospital Pte Ltd, 11 Jalan Tan Tock Seng, Singapore 308433
| | - C.C. Goh
- Nurse Clinician, Tan Tock Seng Hospital Pte Ltd, 11 Jalan Tan Tock Seng, Singapore 308433
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Cho M, Lee DH, Doh EJ, Kim Y, Chung JH, Kim HC, Kim S. Development and clinical validation of a novel photography-based skin erythema evaluation system: a comparison with the calculated consensus of dermatologists. Int J Cosmet Sci 2017; 39:426-434. [DOI: 10.1111/ics.12393] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 02/04/2017] [Indexed: 12/30/2022]
Affiliation(s)
- M. Cho
- Interdisciplinary Program for Bioengineering; Graduate School; Seoul National University; Seoul 110-744 Korea
| | - D.-H. Lee
- Department of Dermatology; Seoul National University Hospital; Seoul 110-744 Korea
| | - E. J. Doh
- Department of Dermatology; Seoul National University Hospital; Seoul 110-744 Korea
| | - Y. Kim
- Department of Biomedical Engineering; Seoul National University Hospital; Seoul 110-744 Korea
| | - J. H. Chung
- Department of Dermatology; Seoul National University Hospital; Seoul 110-744 Korea
| | - H. C. Kim
- Department of Biomedical Engineering; Seoul National University College of Medicine; Seoul 110-799 Korea
- Institute of Medical and Biological Engineering; Seoul National University; Seoul 151-742 Korea
| | - S. Kim
- Department of Biomedical Engineering; Seoul National University College of Medicine; Seoul 110-799 Korea
- Institute of Medical and Biological Engineering; Seoul National University; Seoul 151-742 Korea
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Bazin M, Purohit NK, Shah GM. Comprehensive measurement of UVB-induced non-melanoma skin cancer burden in mice using photographic images as a substitute for the caliper method. PLoS One 2017; 12:e0171875. [PMID: 28187193 PMCID: PMC5302799 DOI: 10.1371/journal.pone.0171875] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 01/26/2017] [Indexed: 11/23/2022] Open
Abstract
The vernier caliper has been used as a gold standard to measure the length, width and height of skin tumors to calculate their total area and volume. It is a simple method for collecting data on a few tumors at a time, but becomes tedious, time-consuming and stressful for the animals and the operator when used for measuring multiple tumors in a large number of animals in protocols such as UVB-induced non-melanoma skin cancer (NMSC) in SKH-1 mice. Here, we show that photographic images of these mice taken within a few minutes under optimized conditions can be subjected to computerized analyses to determine tumor volume and area as accurately and precisely as the caliper method. Unlike the caliper method, the photographic method also records the incidence and multiplicity of tumors, thus permitting comprehensive measurement of tumor burden in the animal. The simplicity and ease of this method will permit more frequent monitoring of tumor burden in long protocols, resulting in the creation of additional data about dynamic changes in progression of cancer or the efficacy of therapeutic intervention. The photographic method can broadly substitute the caliper method for quantifying other skin pathologies.
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Affiliation(s)
- Marc Bazin
- Laboratory for Skin Cancer Research, CHU-Q (CHUL) Quebec University Hospital Research Centre, Laval University, Québec City, Québec, Canada
| | - Nupur K. Purohit
- Laboratory for Skin Cancer Research, CHU-Q (CHUL) Quebec University Hospital Research Centre, Laval University, Québec City, Québec, Canada
| | - Girish M. Shah
- Laboratory for Skin Cancer Research, CHU-Q (CHUL) Quebec University Hospital Research Centre, Laval University, Québec City, Québec, Canada
- * E-mail:
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Williams KJ, Sounderajah V, Dharmarajah B, Thapar A, Davies AH. Simulated Wound Assessment Using Digital Planimetry versus Three-Dimensional Cameras: Implications for Clinical Assessment. Ann Vasc Surg 2017; 41:235-240. [PMID: 28163180 DOI: 10.1016/j.avsg.2016.10.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 06/30/2016] [Accepted: 10/17/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Clinical management of wounds can benefit from objective measures of response to treatment. Wound surface area and volume are objective measures of wound healing. Using a synthetic wound model, we compare the accuracy and reproducibility of 2 commercially available 3-dimensional (3D) cameras against planimetry and water displacement. METHODS Twelve ulcers of various sizes and colors were reproduced in modeling clay and cured. Five naive observers used digital planimetry, water displacement, Eykona camera (Fuel 3D, UK), and Silhouette camera (ARANZ, New Zealand) to measure the wounds. RESULTS When compared with traditional planimetry, wound surface area measurement with Eykona and Silhouette tended to underestimate wounds by 1.7% and 3.7%, respectively. Spearman correlation coefficients were 0.94 (Eykona) and 0.92 (Silhouette). Intraclass correlations for planimetry and the 2 cameras were all 1. Eykona and Silhouette tended to underestimate wound volumes when compared with water displacement by 58% and 23%, respectively. Spearman correlation coefficients were 0.92 (Eykona) and 0.72 (Silhouette). Intraclass correlations for water displacement and the two cameras were all 1. DISCUSSION Serial accurate objective area measurements are feasible as part of ongoing clinical assessment of wounds. 3D cameras are reliable but have not shown superior accuracy to manual planimetry, and financial concerns and IT integration may limit general clinical usage. Volume measurements of wounds are practicable as part of clinical care.
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Affiliation(s)
| | - Viknesh Sounderajah
- Section of Surgery, Charing Cross Hospital, Imperial College London, London, UK
| | - Brahman Dharmarajah
- Section of Surgery, Charing Cross Hospital, Imperial College London, London, UK
| | - Ankur Thapar
- Section of Surgery, Charing Cross Hospital, Imperial College London, London, UK
| | - Alun H Davies
- Section of Surgery, Charing Cross Hospital, Imperial College London, London, UK.
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Comparison of standardized clinical evaluation of wounds using ruler length by width and Scout length by width measure and Scout perimeter trace. Adv Skin Wound Care 2016; 28:116-21. [PMID: 25679463 PMCID: PMC5585126 DOI: 10.1097/01.asw.0000461117.90346.0d] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The study objective was to examine precision in wound measurement using a recently Food and Drug Administration-approved Scout (WoundVision, LLC, Indianapolis, Indiana) device to measure wound length (L) and width (W). Wound perimeter and a ruler measurement of L and W were also made. Images of 40 actual patient wounds were measured using the Scout device. All 3 techniques (length, width, perimeter) demonstrated acceptable within and between reader precision; however, the best precision was in wound perimeter measurement.
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A study of the utility and equivalency of 2 methods of wound measurement: digitized tracing versus digital photography. Adv Skin Wound Care 2016; 28:252-8. [PMID: 25988734 DOI: 10.1097/01.asw.0000465301.37313.57] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine agreement between digitized tracing and digital photography methods in measuring wound area and healing rate, and to compare and contrast the 2 methods on feasibility and utility in patient care and research settings. SETTING Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada. PARTICIPANTS A total of 20 subjects aged 18 years or older with a spinal cord injury and pressure ulcers that were Stage II or higher, and who had received in- or outpatient wound care at the hospital for at least 3 consecutive weeks. METHODS Wound area was measured at weekly intervals. One assessor calculated wound area from a digitized tracing. A second assessor calculated wound area using a wound photograph. Both assessors used Image-J software. The 2 methods were compared for differences in weekly wound area and weekly healing rate. RESULTS Methods were different for wound area (P < .0001), whereas there was no difference between methods in weekly healing rate (P = .9429). CONCLUSIONS The 2 methods are in agreement on the important parameter of healing rate. Both methods are feasible in clinical settings. Wound photography may be more useful than digitized tracings because it simultaneously captures wound appearance.
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Mohammedi K, Potier L, François M, Dardari D, Feron M, Nobecourt-Dupuy E, Dolz M, Ducloux R, Chibani A, Eveno DF, Crea Avila T, Sultan A, Baillet-Blanco L, Rigalleau V, Velho G, Tubach F, Roussel R, Dupré JC, Malgrange D, Marre M. The evaluation of off-loading using a new removable oRTHOsis in DIABetic foot (ORTHODIAB) randomized controlled trial: study design and rational. J Foot Ankle Res 2016; 9:34. [PMID: 27555884 PMCID: PMC4994157 DOI: 10.1186/s13047-016-0163-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 08/09/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Off-loading is essential for diabetic foot management, but remains understudied. The evaluation of Off-loading using a new removable oRTHOsis in DIABetic foot (ORTHODIAB) trial aims to evaluate the efficacy of a new removable device "Orthèse Diabète" in the healing of diabetic foot. METHODS/DESIGN ORTHODIAB is a French multi-centre randomized, open label trial, with a blinded end points evaluation by an adjudication committee according to the Prospective Randomized Open Blinded End-point. Main endpoints are adjudicated based on the analysis of diabetic foot photographs. Orthèse Diabète is a new removable off-loading orthosis (PROTEOR, France) allowing innovative functions including real-time evaluation of off-loading and estimation of patients' adherence. Diabetic patients with neuropathic plantar ulcer or amputation wounds (toes or transmetatarsal) are assigned to one of 2 parallel-groups: Orthèse Diabète or control group (any removable device) according to a central computer-based randomization. Study visits are scheduled for 6 months (days D7 and D14, and months M1, M2, M3, and M6). The primary endpoint is the proportion of patients whose principal ulcer is healed at M3. Secondary endpoints are: the proportion of patients whose principal ulcer is healed at M1, M2 and M6; the proportion of patients whose initial ulcers are all healed at M1, M2, M3, and M6; principal ulcer area reduction; time-related ulcer-free survival; development of new ulcers; new lower-extremity amputation; infectious complications; off-loading adherence; and patient satisfaction. The study protocol was approved by the French National Agency for Medicines and Health Products Safety, and by the ethics committee of Saint-Louis Hospital (Paris). Comprehensive study information including a Patient Information Sheet has been provided to each patient who must give written informed consent before enrolment. Monitoring, data management, and statistical analyses are providing by UMANIS Life Science (Paris), independently to the sponsor. Since 27/10/2013, 13 centres have agreed to participate in this study, 117 participants were included, and 70 have achieved the study schedules. The study completion is expected for the end of 2016, and the main results will be published in 2017. CONCLUSION ORTHODIAB trial evaluates an innovating removable off-loading device, seeking to improve diabetic foot healing (ClinicalTrials.gov identifier: NCT01956162).
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Affiliation(s)
- Kamel Mohammedi
- Department of Endocrinology, Diabetes, and Nutrition, DHU FIRE, Bichat-Claude Bernard Hospital, Assistance Publique Hôpitaux de Paris, Paris, France ; INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France
| | - Louis Potier
- Department of Endocrinology, Diabetes, and Nutrition, DHU FIRE, Bichat-Claude Bernard Hospital, Assistance Publique Hôpitaux de Paris, Paris, France ; INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France ; Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, Paris, France
| | - Maud François
- Centre Hospitalier Universitaire de Reims, Service d'Endocrinologie, Diabète, Nutrition, Reims, France
| | - Dured Dardari
- Department of Diabetology, Endocrinology and Nutrition, Centre hospitalier Sud Francilien, Corbeil-Essonnes, France
| | - Marilyne Feron
- Department of Endocrinology, Diabetes, and Nutrition, DHU FIRE, Bichat-Claude Bernard Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Estelle Nobecourt-Dupuy
- Department of Diabetology, Endocrinology and Nutrition, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Manuel Dolz
- Endocrinology Department, Hôpital Bégin, Saint-Mandé, France
| | - Roxane Ducloux
- APHP, Hôpital Corentin-Celton, Centre de Cicatrisation du Pied du Diabétique, Issy-les-Moulineaux, France
| | - Abdelkader Chibani
- Department of Diabetology, Endocrinology and Nutrition, Centre Hospitalier de Gonesse, Gonesse, France
| | - Dominique-François Eveno
- Department of functional rehabilitation, Centre Hospitalier La Tourmaline, Saint Herblain, France
| | - Teresa Crea Avila
- Department of Diabetology, Centre Hospitalier Régional de Metz - Thionville, Endocrinology and Nutrition, Thionville, France
| | - Ariane Sultan
- Endocrinology-Diabetology-Nutrition Department, CHRU Montpellier, Montpellier, France ; INSERM U1046, University of Montpellier 1, Montpellier, France
| | | | - Vincent Rigalleau
- Nutrition and Diabetology Unit, CHU de Bordeaux, Haut Lévèque Hospital, Pessac, France ; University of Bordeaux, Bordeaux, France
| | - Gilberto Velho
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France
| | - Florence Tubach
- Département d'Epidémiologie et Recherche Clinique, APHP, CIC-EC 1425, Centre de Pharmacoépidémiologie (Cephepi), Paris, France ; Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, Paris, France
| | - Ronan Roussel
- Department of Endocrinology, Diabetes, and Nutrition, DHU FIRE, Bichat-Claude Bernard Hospital, Assistance Publique Hôpitaux de Paris, Paris, France ; INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France ; Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, Paris, France
| | - Jean-Claude Dupré
- Department of Endocrinology, Diabetes, and Nutrition, DHU FIRE, Bichat-Claude Bernard Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Dominique Malgrange
- Centre Hospitalier Universitaire de Reims, Service d'Endocrinologie, Diabète, Nutrition, Reims, France
| | - Michel Marre
- Department of Endocrinology, Diabetes, and Nutrition, DHU FIRE, Bichat-Claude Bernard Hospital, Assistance Publique Hôpitaux de Paris, Paris, France ; INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France ; Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, Paris, France
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O'Shea JE, Thio M, Owen LS, Wong C, Dawson JA, Davis PG. Measurements from preterm infants to guide face mask size. Arch Dis Child Fetal Neonatal Ed 2016; 101:F294-8. [PMID: 25862726 DOI: 10.1136/archdischild-2014-307350] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 02/24/2015] [Indexed: 01/21/2023]
Abstract
OBJECTIVE International guidelines recommend that an appropriately sized face mask for providing positive pressure ventilation should cover the mouth and nose but not the eyes and should not overlap the chin. This study aimed to measure the dimensions of preterm infants' faces and compare these with the size of the most commonly available face masks (external diameter 50 mm) and the smallest masks available (external diameters 35 and 42 mm). METHODS Infants 24-33 weeks' postmenstrual age (PMA) were photographed in a standardised manner. Images were analysed using ImageJ software (National Institute of Health, USA) to calculate the distance from the nasofrontal groove to the mental protuberance. This facial measurement corresponds to the external diameter of an optimally fitting mask. RESULTS A cohort of 107 infants between 24 and 33 weeks' gestational age, including at least 10 infants per week of gestation, was photographed within 72 h after birth and weekly until 33 weeks' PMA. 347 photographs were analysed. Infants of 24, 26, 28, 30 and 32 weeks' PMA had mean (SD) facial measurements of 32 (2), 36 (3), 38 (4), 41 (2) and 43 (4) mm, respectively. There were no significant differences when examined by gender or when small for gestational age infants were excluded. CONCLUSIONS The smallest size of some brands of mask is too large for many preterm infants. Masks of 35 mm diameter are suitable for infants <29 weeks' PMA or 1000 g. Masks of 42 mm diameter are suitable for infants 27-33 weeks' PMA or 750-2500 g.
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Affiliation(s)
- Joyce E O'Shea
- Department of Newborn Research, Royal Women's Hospital, Melbourne, Victoria, Australia Department of Medicine, University College Cork, Cork, Ireland Department of Neonatology, Southern General Hospital, Glasgow, UK
| | - Marta Thio
- Department of Newborn Research, Royal Women's Hospital, Melbourne, Victoria, Australia Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia PIPER-Neonatal Transport Service, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Louise S Owen
- Department of Newborn Research, Royal Women's Hospital, Melbourne, Victoria, Australia Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia Critical Sciences Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Connie Wong
- Department of Newborn Research, Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Jennifer A Dawson
- Department of Newborn Research, Royal Women's Hospital, Melbourne, Victoria, Australia Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia Critical Sciences Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Peter G Davis
- Department of Newborn Research, Royal Women's Hospital, Melbourne, Victoria, Australia Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia Critical Sciences Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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Abstract
The value of using quantitative measures to follow the progress of wound healing is well recognized. However, several methods are in use, and the best way to do this is not always clear from the literature. This article describes the advantages of the linear healing parameter and the disadvantages of the area- and volume-based parameters. The shapes and sizes of wounds influence area- and volume-based parameters, hence these will give biased comparisons. Healing rates based on the linear parameter are independent of initial wound size or shape, and they allow unbiased comparisons within and across studies. A formula for predicting healing time from measurements early in the healing course is presented and discussed. Less precise linear healing measurements that are easy to obtain, and that are as valid as the more precise measurements, are also described.
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Affiliation(s)
- Thomas Gilman
- Hollister Incorporated, Libertyville, IL 60048, USA.
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11
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Santos FTAD, Rocha CA, Cunha SXS, Santos TFAD, Mélo Júnior CH, Lima JMDB, Costa AMB, Pitta GBB. Tissue characterization by photographic imaging during treatment of chronic venous ulcer: technical note. J Vasc Bras 2015. [DOI: 10.1590/1677-5449.0058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Chronic venous ulcers are a medical challenge with a socioeconomic impact. Tissue characterization was quantified by photographic imaging (p-CATIM) of a leg wound treated with Unna boot for 45 days. Three photographs, taken pre-treatment, post Unna boot and post healing were analyzed. Brightness on a 0-255 gray image was re-scaled with black as 0 and adjacent skin as 200. Gray Scale Median (GSM) and the percentages of pixels in each of 14 brightness intervals were calculated. Open ulcer GSM increased from 110 to 159 post Unna boot treatment, reaching 203 post healing. Predominant brightness intervals for the ulcer were 41-153 pre-treatment, 83% of pixels; 133-196 post Unna boot, 80%; and 175-255 post healing, 97%. The GSM of the subcutaneous wound around the ulcer increased from 117 to 137 post healing; the proportion of pixels in the 91-174 interval increased from 67% to 88% (p<0.001). CATIM quantified photographic changes during venous ulcer healing with comparison to the adjacent skin.
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Omar MTA, Alghadir A, Al-Wahhabi KK, Al-Askar AB. Efficacy of shock wave therapy on chronic diabetic foot ulcer: a single-blinded randomized controlled clinical trial. Diabetes Res Clin Pract 2014; 106:548-54. [PMID: 25451894 DOI: 10.1016/j.diabres.2014.09.024] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 07/02/2014] [Accepted: 09/14/2014] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This study was conducted to evaluate the efficacy of extracorporeal shock wave therapy (ESWT) on the healing rate, wound surface area and wound bed preparation in chronic diabetic foot ulcers (DFU). METHODS Thirty eight patients with 45 chronic DFU were randomly assigned into; the ESWT-group (19 patients/24 ulcers) and the control-group (19 patients/21 ulcers). Blinded therapist measured wound surface area (WSA), the percentage of reduction in the WSA, rate of healing and wound bed preparation at baseline, after the end of the interventions (W8), and at 20-week follow-up (W20). The ESWT group received shock wave therapy twice per week for a total of eight treatments. Each ulcer was received ESWT at a frequency of 100 pulse/cm(2), and energy flux density of 0.11mJ/cm(2). All patients received standardized wound care consisting of debridement, blood-glucose control agents, and footwear modification for pressure reduction. RESULTS The overall clinical results showed completely healed ulcers in 33.3% and 54% in ESWT-groups and 14.28% and 28.5% in the control group after intervention (W8), and at follow-up (W20) respectively. The average healing time was significantly lower (64.5 ± 8.06 days vs 81.17 ± 4.35 days, p<0.05) in the ESWT-group compared with the control group. CONCLUSION ESWT-treated ulcers had a significant reduction in wound size and median time required for ulcer healing, with no adverse reactions. So, the ESWT is advocated as an adjunctive therapy in chronic diabetic wound.
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Affiliation(s)
- Mohammed T A Omar
- Faculty of Physical Therapy, Cairo University, Giza, Egypt; Rehabilitation Research Chair, King Saud University, Riyadh, Saudi Arabia.
| | - Ahmad Alghadir
- Rehabilitation Research Chair, King Saud University, Riyadh, Saudi Arabia; Department of Rehabilitation Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | | | - Abeer B Al-Askar
- Physical Therapy Department, King Saud Medical City, Riyadh, Saudi Arabia
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Darestani KD, Mirghazanfari SM, Moghaddam KG, Hejazi S. Leech Therapy for Linear Incisional Skin-Wound Healing in Rats. J Acupunct Meridian Stud 2014; 7:194-201. [DOI: 10.1016/j.jams.2014.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 12/06/2013] [Accepted: 12/11/2013] [Indexed: 11/27/2022] Open
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Okon L, Werth VP. Challenges in measuring outcomes: size assessment of an individual cutaneous lesion. J Am Acad Dermatol 2014; 71:402-4. [PMID: 25037795 DOI: 10.1016/j.jaad.2014.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 04/10/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Lauren Okon
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Victoria P Werth
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania.
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Putzer D, Haselbacher M, Klug S, Nogler M. Assessment of the Size of the Surgical Site in Minimally Invasive Hip Surgery. Adv Wound Care (New Rochelle) 2014; 3:438-444. [PMID: 24940558 DOI: 10.1089/wound.2013.0521] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 03/26/2014] [Indexed: 11/13/2022] Open
Abstract
Objective: Minimally invasive approaches to the hip are beneficial to the patient, but reduce the space available for manipulation by the surgeon. Determining the available working space is important for the development of surgical instruments, to track movements during surgery, as well as to classify the invasiveness of the procedure. Approach: We evaluate three measurement methods to assess the volume of eight surgical sites in a cadaver study. The cavities were filled with an alginate cast to determine its dimensions. Second, the depth, height, and width of the surgical site were measured with a ruler and the volume was calculated. Last, the surface registration method was used to reconstruct the site. Results: We found that the mold filling method provides accurate results in determining the volume of a surgical site. The manual method using a ruler showed excellent reliability, but the calculations tended to overestimate the volume of the surgical site. In contrast, surface reconstruction tended to underestimate the volume of a surgical site, but the results closer resembled the ones derived from the mold filling method. Innovation: We presented a new method to assess the size of the surgical site intraoperatively in minimally invasive hip surgery. Conclusion: The manual method is reliable, but not as accurate as the surface reconstruction, while the mold filling method cannot be used in an intraoperative setup. Although surface reconstruction showed deficits regarding reliability, due to the lack of direct contact to the patient, it remains an appealing technique to measure the surgical site.
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Affiliation(s)
- David Putzer
- Unit of Experimental Orthopedics, Department of Orthopedics, Innsbruck Medical University, Innsbruck, Austria
| | | | - Sebastian Klug
- Unit of Experimental Orthopedics, Department of Orthopedics, Innsbruck Medical University, Innsbruck, Austria
| | - Michael Nogler
- Unit of Experimental Orthopedics, Department of Orthopedics, Innsbruck Medical University, Innsbruck, Austria
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Three-dimensional digital stereophotogrammetry: a reliable and valid technique for measuring scar surface area. Plast Reconstr Surg 2013; 132:204-211. [PMID: 23806921 DOI: 10.1097/prs.0b013e318290f675] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The surface area of scars is an important outcome parameter in scar assessment. It is often used to quantify the extent of scar features, such as pigmentation disturbances, hypertrophy, and contracture. Currently available techniques for measuring the surface area are known to be cumbersome or do not meet the basic clinimetric criteria (i.e., reliability and validity). Three-dimensional stereophotogrammetry is a technique that may improve the quality of surface area measurements. The aim of this study was to investigate the reliability and validity of three-dimensional stereophotogrammetry for measuring scar surface area. METHODS In a cross-sectional study, two independent clinicians photographed and measured 50 scar areas of 32 patients using a handheld stereographic camera, to assess reliability. Subsequently, using planimetry, the scar surface was traced on a transparent sheet (considered the accepted standard) to assess validity. RESULTS Three-dimensional stereophotogrammetry showed good reliability, with an intraclass correlation coefficient of 0.99 and a coefficient of variation of 6.8 percent. To visualize the differences between the two observers, data were plotted and the limits of agreement were calculated at 0 ± 0.19 × mean surface area. Also, excellent validity was found, with a concordance correlation coefficient of 0.99. CONCLUSION This study showed that three-dimensional stereophotogrammetry is a reliable and valid tool for research purposes in the field of scar surface area measurements. CLINICAL QUESTION/LEVEL OF EVIDENCE Diagnostic, I.
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Bhedi A, Saxena AK, Gadani R, Patel R. Digital photography and transparency-based methods for measuring wound surface area. Indian J Surg 2013; 75:111-4. [PMID: 24426404 PMCID: PMC3644165 DOI: 10.1007/s12262-012-0422-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2010] [Accepted: 03/02/2012] [Indexed: 11/25/2022] Open
Abstract
To compare and determine a credible method of measurement of wound surface area by linear, transparency, and photographic methods for monitoring progress of wound healing accurately and ascertaining whether these methods are significantly different. From April 2005 to December 2006, 40 patients (30 men, 5 women, 5 children) admitted to the surgical ward of Shree Sayaji General Hospital, Baroda, had clean as well as infected wound following trauma, debridement, pressure sore, venous ulcer, and incision and drainage. Wound surface areas were measured by these three methods (linear, transparency, and photographic methods) simultaneously on alternate days. The linear method is statistically and significantly different from transparency and photographic methods (P value <0.05), but there is no significant difference between transparency and photographic methods (P value >0.05). Photographic and transparency methods provided measurements of wound surface area with equivalent result and there was no statistically significant difference between these two methods.
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Affiliation(s)
- Amul Bhedi
- Department of Surgery, Government Medical College & Sir Sayajirao General Hospital, Baroda, Gujarat 390001 India
| | - Atul K. Saxena
- Department of Surgery, Government Medical College & Sir Sayajirao General Hospital, Baroda, Gujarat 390001 India
| | - Ravi Gadani
- Department of Surgery, Government Medical College & Sir Sayajirao General Hospital, Baroda, Gujarat 390001 India
| | - Ritesh Patel
- Department of Surgery, Government Medical College & Sir Sayajirao General Hospital, Baroda, Gujarat 390001 India
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Wilson DM, Iwata BA, Bloom SE. Computer-assisted measurement of wound size associated with self-injurious behavior. J Appl Behav Anal 2013; 45:797-808. [PMID: 23322933 DOI: 10.1901/jaba.2012.45-797] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2006] [Accepted: 07/31/2012] [Indexed: 10/25/2022]
Abstract
We evaluated an inexpensive, efficient, and noninvasive technique for measuring tissue damage produced by self-injurious behavior (SIB). The technique involved computerized measurement of wound surface area (WSA) based on digital photographs. In Study 1, we compared photographic measurement to a more commonly used procedure, transparency measurement, in estimating WSA of 20 wound models. Results showed that both methods were reliable and that there was a high degree of correspondence between the 2 sets of measures. In Study 2, we compared photographic WSA measures to direct-observation measures in documenting changes over time in the SIB exhibited by a woman with Prader-Willi syndrome. Results showed that increases and decreases in observed SIB during baseline and treatment conditions corresponded with changes in WSA measures, indicating that the computer-assisted photographic technique may be useful as a corroborative measure or as a primary measure when direct observation of SIB is not feasible.
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O'Meara SM, Bland JM, Dumville JC, Cullum NA. A systematic review of the performance of instruments designed to measure the dimensions of pressure ulcers. Wound Repair Regen 2012; 20:263-76. [PMID: 22564222 DOI: 10.1111/j.1524-475x.2012.00783.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The objective was to undertake a systematic review of the performance of wound measurement instruments used for patients with pressure ulcers. Studies of any design, evaluating methods for estimating wound diameter, depth, surface area, or volume in patients with pressure ulcers were included. Eligible evaluations had to report intra- or inter-rater reliability, accuracy, agreement, or feasibility of methods. Electronic databases and other sources were accessed for study identification. Included studies were critically appraised using a modified checklist for diagnostic test evaluations. Twelve studies were included. Most had methodological problems and/or used inappropriate statistical methods. Reliable methods for measuring pressure ulcer surface area may include: grid tracings from photographs combined with whole plus partial square count; a portable digital pad; and stereophotogrammetry combined with computerized image analysis. The agreement between photographic tracing and direct transparency tracing may be satisfactory (both methods being combined with computerized planimetry). No definitive conclusions could be reached about studies of diameter or depth; this means that there is little evidence to underpin recommendations in clinical guidelines. Evaluations of volume measurement were of poor quality, and there were few data on feasibility. Further primary research is needed to evaluate methods of wound measurement used in clinical practice.
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Affiliation(s)
- Susan M O'Meara
- Department of Health Sciences, University of York, York, United Kingdom.
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Li PN, Li H, Wu ML, Wang SY, Kong QY, Zhang Z, Sun Y, Liu J, Lv DC. A cost-effective transparency-based digital imaging for efficient and accurate wound area measurement. PLoS One 2012; 7:e38069. [PMID: 22666449 PMCID: PMC3364188 DOI: 10.1371/journal.pone.0038069] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 04/30/2012] [Indexed: 01/08/2023] Open
Abstract
Wound measurement is an objective and direct way to trace the course of wound healing and to evaluate therapeutic efficacy. Nevertheless, the accuracy and efficiency of the current measurement methods need to be improved. Taking the advantages of reliability of transparency tracing and the accuracy of computer-aided digital imaging, a transparency-based digital imaging approach is established, by which data from 340 wound tracing were collected from 6 experimental groups (8 rats/group) at 8 experimental time points (Day 1, 3, 5, 7, 10, 12, 14 and 16) and orderly archived onto a transparency model sheet. This sheet was scanned and its image was saved in JPG form. Since a set of standard area units from 1 mm2 to 1 cm2 was integrated into the sheet, the tracing areas in JPG image were measured directly, using the “Magnetic lasso tool” in Adobe Photoshop program. The pixel values/PVs of individual outlined regions were obtained and recorded in an average speed of 27 second/region. All PV data were saved in an excel form and their corresponding areas were calculated simultaneously by the formula of Y (PV of the outlined region)/X (PV of standard area unit) × Z (area of standard unit). It took a researcher less than 3 hours to finish area calculation of 340 regions. In contrast, over 3 hours were expended by three skillful researchers to accomplish the above work with traditional transparency-based method. Moreover, unlike the results obtained traditionally, little variation was found among the data calculated by different persons and the standard area units in different sizes and shapes. Given its accurate, reproductive and efficient properties, this transparency-based digital imaging approach would be of significant values in basic wound healing research and clinical practice.
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Affiliation(s)
- Pei-Nan Li
- Department of Orthopedic Surgery, First Clinical College, Dalian Medical University, Dalian, China
| | - Hong Li
- Department of Cell Biology, College of Medical Sciences, Dalian Medical University, Dalian, China
| | - Mo-Li Wu
- Department of Cell Biology, College of Medical Sciences, Dalian Medical University, Dalian, China
| | - Shou-Yu Wang
- Department of Orthopedic Surgery, First Clinical College, Dalian Medical University, Dalian, China
| | - Qing-You Kong
- Department of Cell Biology, College of Medical Sciences, Dalian Medical University, Dalian, China
| | - Zhen Zhang
- Department of Orthopedic Surgery, First Clinical College, Dalian Medical University, Dalian, China
| | - Yuan Sun
- Department of Cell Biology, College of Medical Sciences, Dalian Medical University, Dalian, China
| | - Jia Liu
- Department of Cell Biology, College of Medical Sciences, Dalian Medical University, Dalian, China
| | - De-Cheng Lv
- Department of Orthopedic Surgery, First Clinical College, Dalian Medical University, Dalian, China
- * E-mail:
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Ladyzynski P, Foltynski P, Molik M, Tarwacka J, Migalska-Musial K, Mlynarczuk M, Wojcicki JM, Krzymien J, Karnafel W. Area of the diabetic ulcers estimated applying a foot scanner-based home telecare system and three reference methods. Diabetes Technol Ther 2011; 13:1101-7. [PMID: 21751890 DOI: 10.1089/dia.2011.0082] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Diabetic foot ulcer area is a basic parameter used for monitoring the wound healing and effectiveness of the treatment applied. TeleDiaFoS (developed earlier in collaboration with the Department and Clinic of Gastroenterology and Metabolic Diseases, Medical University of Warsaw, Warsaw, Poland) is one of just a few systems available that make possible monitoring of the wound size remotely based on the foot scans transmitted to the physician from a patient's home. The aim of this study was to compare the diabetic foot ulcer areas measured using TeleDiaFoS with the results obtained using three reference methods. METHODS The reference measurements were conducted using the elliptical method with a ruler, the wound tracing method and planimetrics with the Visitrak (Smith & Nephew, London, UK) system, and the pattern-coded structured light method with the Silhouette (ARANZ Medical, Christchurch, New Zealand) system. Regression and Bland-Altman analyses were performed. The study group consisted of 23 diabetes patients with plantar foot ulcers. RESULTS Thirty-three wounds were successfully examined. The measurement method influenced the measured area significantly (P=0.00005). The correlation coefficients between TeleDiaFoS and the ruler, Visitrak, and Silhouette methods were 0.949, 0.985, and 0.987, and the limits of agreement equaled -1.3±5.5 cm(2), -0.4±2.2 cm(2), and -0.6±2.1 cm(2), respectively. The strong linear relationships obtained can be used to convert the wound area measured with TeleDiaFoS to the corresponding value of each of the reference methods. CONCLUSIONS The results indicate that the wound area of plantar ulcers in diabetes might be monitored effectively using the TeleDiaFoS system based on the foot scans that the patient can produce at home with no assistance of other persons.
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Affiliation(s)
- Piotr Ladyzynski
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland.
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The reliability of a handheld wound measurement and documentation device in clinical practice. J Wound Ostomy Continence Nurs 2011; 38:260-4. [PMID: 21483270 DOI: 10.1097/won.0b013e318215fc60] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this study was to evaluate the precision (intra- and interrater variability) and usability of a new handheld wound measurement device designed to measure wound surface area and depth across a range of typical wound types. SUBJECTS AND SETTING Raters included a doctor, a nurse, and a novice who was unfamiliar with wound care and the study equipment. Patients of nurse maude, a community-based home health organization in christchurch, new zealand, were assessed at either the wound clinic or the patient's home. METHOD Five repeated area and depth measurements were made on 5 different wounds by the 3 raters, resulting in up to 75 area and depth measurements. The time taken to make each measurement was also recorded. INSTRUMENT This study evaluated a handheld wound imaging, measurement, and documentation device (SilhouetteMobile, ARANZ Medical Limited, Christchurch, New Zealand). RESULTS Variances and coefficients of variation (CV) between raters (interrater) and within raters (intrarater) over the 5 wounds were calculated, as was the intraclass correlation coefficient. Inter- and intrarater precision for surface area was 3.2% and 2.6%, respectively, and depth 13.5% and 5.5%, respectively; intraclass correlation coefficients for area and depth were 99.76% and 98.95%, respectively. Approximately 2 minutes were required to capture photographic documentation and perform area and depth measurements. Use of the device provided practitioners and patients with immediate feedback on wound healing progress. CONCLUSION The device was found to have low intra- and interrater variation. The photographic record and measurements can be collected in approximately 2 minutes and in a noncontact fashion. A novice user was able to use the device proficiently with 1 hour of training.
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Pan CP, Shi Y, Amin K, Greenberg CS, Haroon Z, Faris GW. Wound healing monitoring using near infrared fluorescent fibrinogen. BIOMEDICAL OPTICS EXPRESS 2010; 1:285-294. [PMID: 21258466 PMCID: PMC3005166 DOI: 10.1364/boe.1.000285] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Revised: 07/19/2010] [Accepted: 07/19/2010] [Indexed: 05/30/2023]
Abstract
We demonstrate a method for imaging the wound healing process with near infrared fluorescent fibrinogen. Wound healing studies were performed on a rat punch biopsy model. Fibrinogen was conjugated with a near infrared fluorescent dye and injected into the tail vein. Fibrinogen is a useful protein for tracking wound healing because it is involved in fibrin clot formation and formation of new provisional matrix through transglutaminase's crosslinking activity. Strong fluorescence specific to the wound was observed and persisted for several days, indicating that the fibrinogen is converted to crosslinked fibrin. Administration of contrast agent simultaneously with wound creation led to primary labeling of the fibrin clot, indicating that the wound was in its early phase of healing. Administration on the following day showed labeling on the wound periphery, indicating location of formation of a new provisional matrix. This method may prove to be useful as a diagnostic for basic studies of the wound healing process, in drug development, or in clinical assessment of chronic wounds.
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Affiliation(s)
- Chia-Pin Pan
- Physical Sciences Division, SRI International, 333 Ravenswood Avenue,
Menlo Park, CA. 94025, USA
| | - Yihui Shi
- Biosciences Division, SRI International, 333 Ravenswood Avenue,
Menlo Park, CA. 94025, USA
| | - Khalid Amin
- Dept of Pathology and Laboratory Medicine, University of Kansas, 3901 Rainbow Blvd,
Kansas City, KS 66160, USA
| | - Charles S. Greenberg
- Medical University of South Carolina, 96 Jonathan Lucas Street,
Charleston, SC 29424, USA
| | - Zishan Haroon
- Carolina Institute for Nanomedicine, University of North Carolina,
1079 GMB, CB#7295, Chapel Hill, NC 27599, USA
| | - Gregory W. Faris
- Physical Sciences Division, SRI International, 333 Ravenswood Avenue,
Menlo Park, CA. 94025, USA
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Weber S, Watermann N, Jossinet J, Byrne J, Chantrey J, Alam S, So K, Bush J, O'Kane S, McAdams E. Remote Wound Monitoring of Chronic Ulcers. ACTA ACUST UNITED AC 2010; 14:371-7. [DOI: 10.1109/titb.2010.2042605] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Laplaud AL, Blaizot X, Gaillard C, Morice A, Lebreuilly I, Clément CÃ, Parienti JJ, Dompmartin A. Wound debridement: Comparative reliability of three methods for measuring fibrin percentage in chronic wounds. Wound Repair Regen 2010; 18:13-20. [DOI: 10.1111/j.1524-475x.2009.00555.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Monitoring healing of pressure ulcers: a review of assessment instruments for use in the spinal cord unit. Spinal Cord 2009; 48:92-9. [PMID: 19949418 DOI: 10.1038/sc.2009.146] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Review. OBJECTIVES To identify the pressure ulcer healing assessment instrument that is the best choice for use in spinal cord injury rehabilitation. METHODS Articles were retrieved from PubMed. Inclusion criteria were written in English, published up to December 2008 and describing instruments evaluated in more than one study. Search terms were pressure ulcer, wound healing, severity of illness index, reproducibility of results, sensitivity and specificity. Articles describing pressure ulcer staging scales and articles not describing clinimetric properties of an instrument were excluded. Validity, reliability, responsiveness and feasibility for routine clinical use were described of all instruments evaluated in two or more studies. RESULTS Eleven instruments were described. Clinimetric information was incomplete for all instruments. Clinimetric information was most complete and promising for two instruments: 'ruler length and width' and the 'Sessing' scale. The ruler method showed good intra-rater and inter-rater reliability and good concurrent validity. The 'Sessing' scale has a moderate concurrent validity but was not tested for its responsiveness. CONCLUSION Further study of the clinimetric properties of pressure ulcer assessment instruments is necessary before the best instrument can be selected.
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Treuillet S, Albouy B, Lucas Y. Three-dimensional assessment of skin wounds using a standard digital camera. IEEE TRANSACTIONS ON MEDICAL IMAGING 2009; 28:752-762. [PMID: 19150787 DOI: 10.1109/tmi.2008.2012025] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
In this paper, after an overview of the literature concerning the imaging technologies applied to skin wounds assessment, we present an original approach to build 3-D models of skin wounds from color images. The method can deal with uncalibrated images acquired with a handheld digital camera with free zooming. Compared with the cumbersome imaging systems already proposed, this novel solution uses a low-cost and user-friendly image acquisition device suitable for widespread application in health care centers. However, this method entails the development of a robust image processing chain. An original iterative matching scheme is used to generate a dense estimation of the surface geometry from two widely separated views. The best configuration for taking photographs lies between 15 ( degrees ) and 30 ( degrees ) for the vergency angle. The metric reconstruction of the skin wound is fully automated through self-calibration. From the 3-D model of the skin wound, accurate volumetric measurements are achieved. The accuracy of the inferred 3-D surface is validated by registration to a ground truth and repetitive tests on volume. The global precision around 3% is in accordance with the clinical requirement of 5% for assessing the healing process.
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Affiliation(s)
- Sylvie Treuillet
- Department of Signal and Image Processing of the Ecole Polytechnique and the PRISME Institute of the University of Orleans, 45067 Orleans Cedex, France.
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Abstract
PURPOSE To provide practitioners with evidence-based recommendations for measuring wound size. TARGET AUDIENCE This continuing education activity is intended for physicians and nurses with an interest in wound care. OBJECTIVES After reading this article and taking this test, the reader should be able to: 1. Describe different methods of measuring wound size and their advantages and disadvantages. 2. Discuss a research study conducted to determine the most accurate ruler technique for measuring wounds. 3. Identify evidence-based wound measurement data and recommendations for clinical practice.
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Kecelj-Leskovec N, Jezersek M, Mozina J, Pavlović MD, Lunder T. Measurement of venous leg ulcers with a laser-based three-dimensional method: comparison to computer planimetry with photography. Wound Repair Regen 2008; 15:767-71. [PMID: 17971024 DOI: 10.1111/j.1524-475x.2007.00300.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A lack of reproducible and practical methods to assess venous leg ulcer healing is a major problem encountered by investigators evaluating various treatments. We aimed to compare a new laser-based three-dimensional (3D) measuring device with computer planimetry with photography for the assessment of venous leg ulcers, and to estimate the reliability of measurements by the methods. Sixty measurements of perimeter and area of 15 venous leg ulcers, < 10 cm in diameter (eight patients; six females; mean age 71 years; range 52-90 years), were made with both methods. Two independent investigators performed the measurements at the first visit and 2-4 weeks later. The precision and accuracy of the methods were determined and compared. The accuracies for computer planimetry with photography in comparison with the laser-based 3D measuring method were 8.4% for perimeter and 16.0% for area measurements. The precisions of ulcer area and perimeter measurements did not differ significantly between the two methods (p=0.993 and 0.201, respectively). The main advantage of the laser-based measuring method is the 3D ulcer measurement with a precision of 7.5%, which also takes into account distortions created by the limb convexity. The system is accurate, inexpensive, user-friendly, and appropriate for everyday practice.
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Affiliation(s)
- Nada Kecelj-Leskovec
- Department of Dermatovenereology, University Medical Centre Ljubljana, Ljubljana, Slovenia
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Saltzman CL, Zimmerman MB, Holdsworth RL, Beck S, Hartsell HD, Frantz RA. Effect of initial weight-bearing in a total contact cast on healing of diabetic foot ulcers. J Bone Joint Surg Am 2004; 86:2714-9. [PMID: 15590858 DOI: 10.2106/00004623-200412000-00019] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although total contact casts are highly effective in the treatment of plantar ulcerations in patients with diabetes mellitus, they are not widely used. One reason for this lack of acceptance may be the difficulty in complying with an initial period of non-weight-bearing, as is generally recommended by physicians. We performed this study to assess the effects of early weight-bearing on the healing rates of plantar ulcers in patients with diabetes who were wearing a total contact cast. METHODS Forty patients with diabetes mellitus who had a noninfected forefoot or midfoot ulcer were treated with total contact casts until healing or for thirteen weeks. The patients were instructed to bear no weight on the cast for forty-eight hours after it was applied. Using an embedded step counter, we measured the number of steps taken during the first twenty-four and forty-eight hours, the first week, and each subsequent two-week period after application of the cast. We removed the cast, measured the radius of the ulcer, and then reapplied the cast at the end of the first week and of each subsequent two-week period after cast application until the ulcer healed or for thirteen weeks. We then determined the effect of the number of steps during various time intervals on the rate of ulcer healing (defined as a change in the ulcer radius). RESULTS Most patients walked on the cast in the immediate postoperative period. The effects of modest amounts of early weight-bearing on ulcer healing rates appear negligible. Only excessive walking during the first twenty-four or forty-eight hours after cast application is likely to prolong the duration of cast treatment. CONCLUSIONS Moderate early weight-bearing retards healing of plantar ulcers only minimally in patients with diabetes mellitus treated with total contact casts. Allowing patients to walk immediately after placement of a total contact cast may improve their acceptance of this form of therapy. LEVEL OF EVIDENCE Therapeutic study, Level II-1 (prospective cohort study). See Instructions to Authors for a complete description of levels of evidence.
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Affiliation(s)
- Charles L Saltzman
- Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics-JPP, 200 Hawkins Drive, Iowa City, IA 52242, USA.
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Jamison RN, Fanciullo GJ, Baird JC. Usefulness of pain drawings in identifying real or imagined pain: Accuracy of pain professionals, nonprofessionals, and a decision model. THE JOURNAL OF PAIN 2004; 5:476-82. [PMID: 15556825 DOI: 10.1016/j.jpain.2004.08.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2004] [Revised: 08/03/2004] [Accepted: 08/10/2004] [Indexed: 11/20/2022]
Abstract
UNLABELLED The aim of this study was to determine the accuracy of pain specialists, nonprofessionals, and a decision model in judging whether a pain diagram was marked by a patient with chronic pain or by a healthy volunteer. Two hundred twenty-eight pain drawings were shown in random order to 10 pain medicine physicians, 10 pain medicine fellows, 10 nonphysician specialists, and 10 nonprofessionals. One half of the drawings (n = 114) had been produced by patients treated at a pain center and the other half (n = 114) by healthy individuals who were instructed to mark the diagrams as if they had a pain problem. The nonprofessionals were found to be 51.5% accurate, pain medicine fellows 52.7%, nonphysician specialists 54.3%, and pain medicine physicians 55.2 % accurate at distinguishing drawings by actual pain patients from drawings from volunteers without pain. A decision model was able to achieve 68.9% accuracy in determining which drawings were made by pain patients and which drawings were made by healthy individuals. The results suggest that subjective assessment of pain drawings alone is not useful in determining whether someone has real or imagined pain. A decision model that makes decisions on the basis of the number of highlighted squares on the pain diagram can identify real pain drawings with greater accuracy than humans. PERSPECTIVE Pain drawings are clinically useful but have limitations. This study illustrates some of the benefits of computerized pain assessment and highlights the importance of not judging patients on the basis of one source of information.
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Affiliation(s)
- Robert N Jamison
- Department of Anesthesia and Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Omar AA, Mavor AID, Jones AM, Homer-Vanniasinkam S. Treatment of venous leg ulcers with Dermagraft. Eur J Vasc Endovasc Surg 2004; 27:666-72. [PMID: 15121121 DOI: 10.1016/j.ejvs.2004.03.001] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2004] [Indexed: 11/18/2022]
Abstract
BACKGROUND A number of different treatment approaches have been recommended for the treatment of venous ulceration, including local ulcer treatment, compression and drug therapy. Recent advances in tissue engineering have resulted in living tissues being developed for cutaneous wound repair and skin replacement. The aim of this pilot study was to compare the rate of healing of venous ulcers in patients treated with Dermagraft (a human fibroblast-derived dermal replacement) and compression therapy or compression therapy alone. METHODS A total of 18 patients with venous ulceration of the leg were recruited into the pilot study. Ten patients were treated with Dermagraft and compression therapy, and eight patients were treated with compression therapy alone. Healing was assessed by ulcer tracing and computerised planimetry. Skin perfusion was measured by laser Doppler. RESULTS Five (50%) of the patients treated with Dermagraft and one (12.5%) control patient had healed by the end of the 12-week study period (NS). The total ulcer area rate of healing and linear rate of healing was significantly improved in patients treated with Dermagraft (P=0.001 and P=0.006, respectively, Mann-Whitney U-test). The number of capillaries increased in both the treatment and control group. Peri-ulcer skin perfusion increased by 20% in patients treated with Dermagraft, compared with 4.9% in the control group. CONCLUSION The data from this small pilot study suggests that Dermagraft is associated with improved healing of venous ulceration. Following this pilot study, further clinical studies are needed to confirm the validity of these results in 'hard to heal' venous leg ulcers.
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Affiliation(s)
- A A Omar
- Department of General Surgery, Faculty of Medicine, Shebinel-Kom, Egypt
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Woodbury MG, Houghton PE, Campbell KE, Keast DH. Development, Validity, Reliability, and Responsiveness of a New Leg Ulcer Measurement Tool. Adv Skin Wound Care 2004; 17:187-96. [PMID: 15360028 DOI: 10.1097/00129334-200405000-00018] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To develop and validate an assessment tool--the Leg Ulcer Measurement Tool (LUMT)--that would be able to detect changes in the appearance of lower extremity ulcers. SUBJECTS Twenty-two subjects with chronic leg ulcers of various etiologies (arterial, venous, diabetes) participated in the validation study. DESIGN An interdisciplinary panel consisting of 9 local wound care specialists confirmed content validity. Concurrent criterion validity was determined by correlation of the size domain (1 of 14 clinician-rated domains in the LUMT) with acetate tracing measurement of wound surface area. Reliability was determined using repeated assessments by 4 wound care specialist and 2 inexperienced evaluators; responsiveness was determined using monthly reassessments by a single rater for 4 months. RESULTS Concurrent criterion validity was r = 0.82. Excellent values of intrarater and interrater reliability (ICC > 0.75) were obtained for total LUMT scores and for many of the 14 individual domains; however, several domains were found to be less reproducible. The LUMT detected change in wound status over time (responsiveness coefficient = 0.84). CONCLUSION The LUMT can be used by 1 or more assessors, with relatively little previous training, to make reproducible evaluations of lower extremity ulcer appearance and to document change in appearance over time. The LUMT represents a novel assessment tool specifically designed and validated for clinical or research use on chronic leg ulcers.
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Affiliation(s)
- M Gail Woodbury
- Rehabilitation and Geriatric Care Division, Lawson Health Research Institute, Parkwood Hospital, St. Joseph's Health Care London, Ontario, Canada
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Graumlich JF, Blough LS, McLaughlin RG, Milbrandt JC, Calderon CL, Agha SA, Scheibel LW. Healing pressure ulcers with collagen or hydrocolloid: a randomized, controlled trial. J Am Geriatr Soc 2003; 51:147-54. [PMID: 12558709 DOI: 10.1046/j.1532-5415.2003.51051.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To compare the effects of topical collagen and hydrocolloid on pressure ulcer healing. DESIGN Randomized (allocation concealed), single-blind (outcome assessors), controlled trial with 8-week follow-up. SETTING Eleven nursing homes in central Illinois. PARTICIPANTS Sixty-five patient-residents with Stage II or III pressure ulcers: median age 83.1, median Braden score 12, 63% female, 80% Stage II ulcers, and 20% Stage III ulcers. Exclusion criteria included cellulitis and osteomyelitis. INTERVENTION Thirty-five patients were allocated to topical collagen daily, 30 to topical hydrocolloid twice weekly. MEASUREMENTS The primary outcome was complete healing within 8 weeks. Secondary outcomes were time to heal, ulcer area healed per day, linear healing of wound edge, and cost of therapy. RESULTS Analysis by intention to treat revealed similar complete ulcer healing within 8 weeks in collagen (51%) and hydrocolloid (50%) recipients (difference 1%, 95% confidence interval (CI) = 26-29%). Mean healing time was similar: collagen healed in 5 weeks (95% CI = 4-6), hydrocolloid healed in 6 weeks (95% CI = 5-7). Mean area healed per day was 6 mm(2)/d in both treatment groups. Mean linear healing of the wound edge was 3 mm in both groups. In multivariate analysis, baseline ulcer depth was the only independent predictor of complete ulcer healing within 8 weeks (odds ratio = 0.56, 95% CI = 0.38-0.81). Cost analysis favored hydrocolloid. CONCLUSIONS There were no significant differences in healing outcome between collagen and hydrocolloid. Collagen was more expensive and offered no major benefits to patients otherwise eligible for hydrocolloid treatment.
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Affiliation(s)
- James F Graumlich
- Department of Biomedical and Therapeutic Sciences and Medicine, University of Illinois College of Medicine, Peoria, Illinois 61605, USA.
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Lucas C, Classen J, Harrison D, De H. Pressure ulcer surface area measurement using instant full-scale photography and transparency tracings. Adv Skin Wound Care 2002; 15:17-23. [PMID: 11902356 DOI: 10.1097/00129334-200201000-00009] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE An essential element in pressure ulcer management is the assessment of wound healing through measurement. The purpose of this study was to investigate the intraobserver and interobserver reliability of measuring pressure ulcers using instant full-scale photography combined with transparency tracings. SUBJECTS 26 patients in 3 long-term-care facilities. METHODS Duplicate photographs of 30 wounds from 26 subjects were obtained once a week over a period of 2 weeks, resulting in 120 photographs. Duplicate tracings of the photographs were subsequently assessed by 2 independent observers, resulting in 480 observations. The Intraclass Correlation Coefficient (ICC) was used as an indicator of chance-corrected agreement to estimate the relative reliability for the interobserver and intraobserver data. An Altman-Bland plot was also constructed to measure the relationship between interobserver differences and wound surface area. RESULTS Analysis of the data showed that all measurement comparisons were highly reliable (ICCs = 0.99). No statistical differences between observed surface areas could be demonstrated. CONCLUSIONS The combined wound measurement method described in this study represents a simple, practical, and inexpensive technique to accurately monitor and evaluate pressure ulcer healing. An instant full-scale photographic technique combined with transparency tracings of a wound should be considered for wound measurement, rather than each technique used independently. The results of this study indicate that measurements obtained with this combined method are highly reliable within and between observers.
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Affiliation(s)
- Cees Lucas
- Department of Research and Innovation in Health Sciences, University of Professional Education, Hogeschool van Amsterdam, The Netherlands
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Langemo DK, Melland H, Olson B, Hanson D, Hunter S, Henly SJ, Thompson P. Comparison of 2 wound volume measurement methods. Adv Skin Wound Care 2001; 14:190-6. [PMID: 11902344 DOI: 10.1097/00129334-200107000-00011] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare 2 wound volume measurement techniques, the Kundin device and stereophotogrammetry, on 2 wound shapes. DESIGN Using 2 wound measurement techniques, the interrater and intrarater reliability and the bias and standard error of measurement of an L-shaped and a pear-shaped plaster of paris wound model were assessed. SETTING A clinical laboratory of a school of nursing. PARTICIPANTS Twenty-four raters, all but 2 being registered nurses, measured each of the wounds using both techniques. INTERVENTIONS Each rater measured each wound twice using each method in a randomly assigned order defined on a card that was drawn from a box. Measurements were recorded on a researcher-designed data collection form, which included some demographic data related to each participant. MAIN OUTCOME MEASURES The study hypothesis was that there would be no significant difference in accuracy between the 2 wound volume measurement methods. RESULTS The least biased and most accurate technique was stereophotogrammetry, with the smallest standard of error of measurement. Interrater reliability of average ratings was identical for both methods at 0.98. For single ratings, stereophotogrammetry was slightly higher than the Kundin device. Intrarater reliability was higher on the pear-shaped wound for the Kundin device, which had lower interrater reliability, suggesting that nurses were consistent in the direction and size of personal error. Intrarater reliability for stereophotogrammetry was identical to that of the Kundin device for the L-shaped wound and lower for the pear-shaped wound. CONCLUSIONS Although both techniques have acceptable accuracy, stereophotogrammetry is more accurate and has more clinical applications.
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Affiliation(s)
- D K Langemo
- University of North Dakota College of Nursing, Grand Forks, USA
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Abstract
The aim of this study was to design and test a pressure ulcer severity score based on assessment by experienced clinicians. Fifty pressure ulcers were each evaluated independently by seven experienced clinicians, using a scale that ranged from 0 (mildest damage) to 10 (most severe). Ulcer characteristics were analysed to determine which factors related to the assessments. A second set of 50 ulcers was used to test the validity of the resulting scoring system. Inter- and intra-observer reliability were tested in a further 10 pressure ulcers. A multivariate linear model was produced, based on the following three variables: colour (CO-matched-matched) in the wound base; depth (DE) of the ulcer; and mean diameter (D) of the wound ('CODED'). The coefficients for each variable were rounded to yield points in an additive equation, the CODED score. This score had a high correlation (r = 0.92, P < 0.001) with the second set of evaluations, used to test the score performance. The CODED score is a simple and valid tool to quantify the progress of a pressure ulcer. It has a high correlation with the severity assessment of experienced clinicians and is reliable when used by non-experienced observers.
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Affiliation(s)
- J I Emparanza
- Clinical Epidemiology Unit, Hospital Aranzazu, Osakidetza-Servicio Vasco de Salud, San Sebastian, Spain
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Affiliation(s)
- A B Wysocki
- Ronald O. Perelman Department of Dermatology, New York University Medical Center, NY 10016, USA
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Solomon C, Munro AR, Van Rij AM, Christie R. The use of video image analysis for the measurement of venous ulcers. Br J Dermatol 1995; 133:565-70. [PMID: 7577585 DOI: 10.1111/j.1365-2133.1995.tb02706.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The accurate measurement of the size of skin wounds and ulceration is important for comparing the efficiency of treatment modalities and for monitoring progress in the individual patient. Although various methods of differing sophistication are in use, many of the common simpler techniques lack accuracy and reliability. We describe a new technique of ulcer measurement which uses video image recording, capture and computer analysis. A method of correcting for limb convexity in a two-dimensional image is presented. The method has an overall accuracy of 1.82% and a clinical precision of 3.41%, both of which are significantly better than acetate tracings or photographic methods. The technique is simple and rapid, and once established it incurs minimal ongoing costs.
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Affiliation(s)
- C Solomon
- Department of Surgery, University of Otago Medical School, Dunedin, New Zealand
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Abstract
Seventeen drawings of localised low-back pain were analysed by two assessors using 4 systems. Three were grid-based systems and one was by computer. The mean area or 'extent' was calculated to be 7.7%, 4.7%, 3.6% and 2.3% of the body outline using 45, 200, 560 and 61,102 section analyses, respectively. The computer-assisted method provided a significantly lower estimate of pain extent than the grid-based assessments as expected. Analysis of variance showed that the method of analysis provided greater source of variation than raters (P < 0.0001). Inter-rater reliability was high using all 4 systems calculated using intraclass correlation and the kappa statistic. Correlation coefficients of extent between the systems varied from 0.46 to 0.94. Correlation was highest between systems of adjacent magnitude of sections. It is concluded that grid-based assessment of small areas overestimates the actual area of pain and this may account for the lack of sensitivity to change in clinical status.
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Affiliation(s)
- Peter Bryner
- School of Chiropractic and Osteopathy, RMIT, Faculty of Biomedical and Health Sciences, Bundoora, Victoria 3083 Australia
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