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Stewart S, Juang D, Aguayo P. Pediatric burn review. Semin Pediatr Surg 2022; 31:151217. [PMID: 36370620 DOI: 10.1016/j.sempedsurg.2022.151217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Shai Stewart
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO USA
| | - David Juang
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO USA
| | - Pablo Aguayo
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO USA.
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2
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Claes KEY, Hoeksema H, Robbens C, Verbelen J, Dhooghe NS, De Decker I, Monstrey S. The LDI Enigma, Part I: So much proof, so little use. Burns 2021; 47:1783-1792. [PMID: 33658147 DOI: 10.1016/j.burns.2021.01.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 12/08/2020] [Accepted: 01/25/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Laser Doppler imaging (LDI) is still not an ubiquitous part of burn care worldwide despite reported accuracy rates of more than 95%, which is significantly higher than clinical assessment alone (50-75%). The aims of Part I of this survey study are: to identify the most important barriers for the use of LDI and to provide useful recommendations for efficient implementation in routine burn care. The actual interpretation and use of LDI measurements is discussed in the Enigma Part II article. MATERIAL AND METHODS 1. Informative interviews with 15 representatives of burn centers without LDI. 2. A survey among 51 burn centers with LDI by means of an extensive questionnaire. 3. In-depth interviews with 21 of the participating centers. RESULTS 1. All 15 centers without LDI indicated that cost of purchase in combination with maintenance of the LDI device, as well as personnel costs were the reason for not buying, while 12 (80%) also rated the current scientific evidence as insufficient. 2. Twenty-seven burn centers with an LDI (53%) participated and filled in almost the entire questionnaire. In 5 centers, cost delayed the purchase of LDI. The hospital/department paid for the LDI device in 62% of the burn centers and in 88% also for maintenance and salaries. The LDI operators were mainly surgeons (47%) or nurses (42%). In more than half of the burn centers (52%), between 2 and 5 people were trained and certified to use an LDI. In 50% of burn centers, the interpretation of the LDI scan was done by the same person doing the actual measurements. Eighty-nine percent of the burn centers considered the accuracy of the LDI scan as mainly to almost completely accurate. In case of real discrepancy between clinical diagnosis and LDI, in 48% of the burn centers (13/27) the surgeon still relied more on the clinical diagnosis despite reporting this high or almost complete accuracy rate of the LDI. CONCLUSIONS Barriers for the routine implementation of LDI were: 1. cost of purchasing and using an LDI combined with health care systems that inadequately reimburse non-surgical management; 2. lack of awareness of or ongoing skepticism towards the scientific evidence supporting LDI use; and 3. organizational constraints combined with logistical limitations. Our recommendations for wider use of LDI technology include: 1. a cost-effective reimbursement of LDI use combined with a more appropriate valuation of expert conservative management compared to surgical therapy; 2. increased use of LDI for every mixed depth burn and; 3. specialized LDI teams to improve burn procedural flexibility and to enable embedding LDI use in the burn care routine. Implementing these measures would promote the highest standards for LDI measurements and interpretation resulting in optimal care with mutual benefits for the hospital, for burn care teams and, most importantly, for the patients.
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Affiliation(s)
- Karel E Y Claes
- Burn Center, Ghent University Hospital, 9000 Gent, Belgium; Department of Plastic Surgery, Ghent University Hospital, 9000 Ghent, Belgium.
| | - Henk Hoeksema
- Burn Center, Ghent University Hospital, 9000 Gent, Belgium; Department of Plastic Surgery, Ghent University Hospital, 9000 Ghent, Belgium
| | - Cedric Robbens
- Burn Center, Ghent University Hospital, 9000 Gent, Belgium
| | - Jozef Verbelen
- Burn Center, Ghent University Hospital, 9000 Gent, Belgium
| | - Nicolas S Dhooghe
- Department of Plastic Surgery, Ghent University Hospital, 9000 Ghent, Belgium
| | | | - Stan Monstrey
- Burn Center, Ghent University Hospital, 9000 Gent, Belgium; Department of Plastic Surgery, Ghent University Hospital, 9000 Ghent, Belgium
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3
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Gibson ALF, Carney BC, Cuttle L, Andrews CJ, Kowalczewski CJ, Liu A, Powell HM, Stone R, Supp DM, Singer AJ, Shupp JW, Stalter L, Moffatt LT. Coming to Consensus: What Defines Deep Partial Thickness Burn Injuries in Porcine Models? J Burn Care Res 2020; 42:98-109. [PMID: 32835360 PMCID: PMC7856457 DOI: 10.1093/jbcr/iraa132] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Deep partial thickness burns are clinically prevalent and difficult to diagnose. In order to develop methods to assess burn depth and therapies to treat deep partial thickness burns, reliable, accurate animal models are needed. The variety of animal models in the literature and the lack of precise details reported for the experimental procedures make comparison of research between investigators challenging and ultimately affect translation to patients. They sought to compare deep partial thickness porcine burn models from five well-established laboratories. In doing so, they uncovered a lack of consistency in approaches to the evaluation of burn injury depth that was present within and among various models. They then used an iterative process to develop a scoring rubric with an educational component to facilitate burn injury depth evaluation that improved reliability of the scoring. Using the developed rubric to re-score the five burn models, they found that all models created a deep partial thickness injury and that agreement about specific characteristics identified on histological staining was improved. Finally, they present consensus statements on the evaluation and interpretation of the microanatomy of deep partial thickness burns in pigs.
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Affiliation(s)
- Angela L F Gibson
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Bonnie C Carney
- Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC.,Department of Biochemistry and Molecular and Cellular Biology, Georgetown University School of Medicine, Washington, DC
| | - Leila Cuttle
- School of Biomedical Science and Institute of Health and Biomedical Innovation, Queensland University of Technology, Children's Health Research Centre, South Brisbane, Queensland, Australia
| | - Christine J Andrews
- Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Christine J Kowalczewski
- Burn and Soft Tissue Research, United States Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - Aiping Liu
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Heather M Powell
- Department of Materials Science and Engineering, The Ohio State University, Columbus, Ohio.,Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio.,Research Department, Shriners Hospitals for Children, Cincinnati, Ohio
| | - Randolph Stone
- Burn and Soft Tissue Research, United States Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - Dorothy M Supp
- Research Department, Shriners Hospitals for Children, Cincinnati, Ohio.,Department of Surgery, University of Cincinnati, College of Medicine, Ohio.,Center for Stem Cell and Organoid Medicine, Cincinnati Children's Hospital Medical Center, Ohio
| | - Adam J Singer
- Department of Emergency Medicine, Stony Brook University, New York
| | - Jeffrey W Shupp
- Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC.,Department of Biochemistry and Molecular and Cellular Biology, Georgetown University School of Medicine, Washington, DC.,Department of Surgery, Georgetown University School of Medicine, Washington DC
| | - Lily Stalter
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Lauren T Moffatt
- Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC.,Department of Biochemistry and Molecular and Cellular Biology, Georgetown University School of Medicine, Washington, DC.,Department of Surgery, Georgetown University School of Medicine, Washington DC
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4
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Jan SN, Khan FA, Bashir MM, Nasir M, Ansari HH, Shami HB, Nazir U, Hanif A, Sohail M. Comparison of Laser Doppler Imaging (LDI) and clinical assessment in differentiating between superficial and deep partial thickness burn wounds. Burns 2018; 44:405-413. [DOI: 10.1016/j.burns.2017.08.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/25/2017] [Accepted: 08/28/2017] [Indexed: 11/25/2022]
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5
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Sun LT, Friedrich E, Heuslein JL, Pferdehirt RE, Dangelo NM, Natesan S, Christy RJ, Washburn NR. Reduction of burn progression with topical delivery of (antitumor necrosis factor-α)-hyaluronic acid conjugates. Wound Repair Regen 2012; 20:563-72. [PMID: 22712482 DOI: 10.1111/j.1524-475x.2012.00813.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Accepted: 02/29/2012] [Indexed: 02/01/2023]
Abstract
In this study, we explored whether topical application of antibodies targeting tumor necrosis factor-α (TNF-α) or interleukin-6 (IL-6) conjugated to hyaluronic acid (HA) could reduce the extension of necrosis by modulating inflammation locally in a partial-thickness rat burn model. Partial-thickness to deep partial-thickness burn injuries present significant challenges in healing, as these burns often progress following the initial thermal insult, resulting in necrotic expansion and increased likelihood of secondary complications. Necrotic expansion is driven by a microenvironment with elevated levels of pro-inflammatory mediators, and local neutralization of these using antibody conjugates could reduce burn progression. Trichrome-stained tissue sections indicated the least necrotic tissue in (anti-TNF-α)-HA-treated sites, while (anti-IL-6)-HA-treated sites displayed similar outcomes to saline controls. This was confirmed by vimentin immunostaining, which demonstrated that HA treatment alone reduced burn progression by nearly 30%, but (anti-TNF-α)-HA reduced it by approximately 70%. At all time points, (anti-TNF-α)-HA-treated sites showed reduced tissue levels of IL-1β compared to controls, suggesting inhibition of a downstream mediator of inflammation. Decreased macrophage infiltration in (anti-TNF-α)-HA-treated sites compared to controls was elucidated by immunohistochemical staining of macrophages, suggesting a reduction in overall inflammation in all time points. These results suggest that local targeting of TNF-α may be an effective strategy for preventing progression of partial-thickness burns.
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Affiliation(s)
- Liang Tso Sun
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA 15213, USA
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6
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Kim KH, Pierce MC, Maguluri G, Park BH, Yoon SJ, Lydon M, Sheridan R, de Boer JF. In vivo imaging of human burn injuries with polarization-sensitive optical coherence tomography. JOURNAL OF BIOMEDICAL OPTICS 2012; 17:066012. [PMID: 22734768 DOI: 10.1117/1.jbo.17.6.066012] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
The accurate determination of burn depth is critical in the clinical management of burn wounds. Polarization-sensitive optical coherence tomography (PS-OCT) has been proposed as a potentially non-invasive method for determining burn depth by measuring thermally induced changes in the structure and birefringence of skin, and has been investigated in pre-clinical burn studies with animal models and ex vivo human skin. In this study, we applied PS-OCT to the in-vivo imaging of two pediatric burn patients. Deep and superficial burned skins along with contralateral controls were imaged in 3D. The imaging size was 8 mm × 6 mm × 2 mm in width, length, and depth in the air respectively, and the imaging time was approximately 6 s per volume. Superficially burned skins exhibited the same layered structure as the contralateral controls, but more visible vasculature and reduced birefringence compared to the contralateral controls. In contrast, a deeply burned skin showed loss of the layered structure, almost absent vasculature, and smaller birefringence compared to superficial burns. This study suggested the vasculature and birefringence as parameters for characterizing burn wounds.
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Affiliation(s)
- Ki Hean Kim
- Pohang University of Science and Technology, Department of Mechanical Engineering, Pohang 790-784, Republic of Korea.
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7
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Kaiser M, Yafi A, Cinat M, Choi B, Durkin AJ. Noninvasive assessment of burn wound severity using optical technology: a review of current and future modalities. Burns 2010; 37:377-86. [PMID: 21185123 DOI: 10.1016/j.burns.2010.11.012] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Revised: 08/30/2010] [Accepted: 11/10/2010] [Indexed: 11/19/2022]
Abstract
Clinical examination alone is not always sufficient to determine which burn wounds will heal spontaneously and which will require surgical intervention for optimal outcome. We present a review of optical modalities currently in clinical use and under development to assist burn surgeons in assessing burn wound severity, including conventional histology/light microscopy, laser Doppler imaging, indocyanine green videoangiography, near-infrared spectroscopy and spectral imaging, in vivo capillary microscopy, orthogonal polarization spectral imaging, reflectance-mode confocal microscopy, laser speckle imaging, spatial frequency domain imaging, photoacoustic microscopy, and polarization-sensitive optical coherence tomography.
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Affiliation(s)
- Meghann Kaiser
- Department of Surgery, Division of Trauma, Burns, Critical Care and Acute Care Surgery, University of California, Irvine, Orange, CA 92806, USA.
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8
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Sainsbury DCG. Critical evaluation of the clinimetrics of laser Doppler imaging in burn assessment. J Wound Care 2008; 17:193-4, 196-8, 200. [PMID: 18546992 DOI: 10.12968/jowc.2008.17.5.29155] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Just under a third of clinical assessments of intermediate burn depth overestimate the extent of the injury, potentially resulting in unnecessary surgery. Research evidence suggests that laser Doppler imaging may be a more accurate alternative.
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9
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Abstract
The successful management of burns and related injuries requires a comprehensive team approach at a designated burn center. This team should consist of burn surgeons, burn nurses, respiratory therapists, physical therapists, occupational therapists, clinical nutritionists, social workers, chaplains, and other clinical consultants. This article focuses specifically on the management of thermal burns and inhalational injuries, with an emphasis on assessment, resuscitation, and critical care management. It also discusses special considerations related to burned trauma patients.
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Affiliation(s)
- Corinna P Sicoutris
- Division of Traumatology and Surgical Critical Care, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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10
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Rawlins JM, Lam WL, Karoo RO, Naylor IL, Sharpe DT. Quantifying collagen type in mature burn scars: a novel approach using histology and digital image analysis. J Burn Care Res 2006; 27:60-5. [PMID: 16566538 DOI: 10.1097/01.bcr.0000192266.14329.7b] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Using Herovici staining and digital image analysis, we have studied the collagen subtype and fiber orientation in mature burn scars. These techniques have shown mature burn scars to have increased type I/type III collagen ratios compared with normal skin. Additionally, the collagen orientation of burn scars has been shown to be thickened, tightly packed, and lacking the "basket weave" appearance of normal skin specimens. These techniques allow the differentiation of type I collagen from type III collagen, the assessment of collagen orientation, and the analysis of scar architecture in terms of epidermis and papillary/reticular dermis contribution. These findings are important clinically because collagen subtype and fiber orientation may predict future scar activity. Any attempt to modify the scarring process can be directly measured and compared using this easily reproducible technique.
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Affiliation(s)
- Jeremy M Rawlins
- Plastic Surgery and Burns Research Unit, Department of Biomedical Sciences, University of Bradford, Bradford, West Yorkshire, United Kingdom
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11
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Stewart CJ, Frank R, Forrester KR, Tulip J, Lindsay R, Bray RC. A comparison of two laser-based methods for determination of burn scar perfusion: laser Doppler versus laser speckle imaging. Burns 2006; 31:744-52. [PMID: 16129229 DOI: 10.1016/j.burns.2005.04.004] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2004] [Indexed: 11/27/2022]
Abstract
UNLABELLED Laser Doppler perfusion imaging (LDI) is an established technique for early assessment of burn depth to help determine a course of treatment. Laser speckle perfusion imaging (LSPI) is an alternative laser based, non-invasive perfusion monitoring technique that offers rapid and high resolution images of tissue. We have evaluated the ability of the LSPI instrument in determining and monitoring burn scar perfusion over time and compared it with the LDI instrument as a standard. METHODS Ten patients with hypertrophic burn scars (time since injury: 1-8 months) were recruited. Burn scars were scanned with both instruments (LSPI and LDI) monthly over a period of 11 months. Clinical grading of the burn scars was assessed on every scan date using the Vancouver burn scar scale. RESULTS Comparison of the perfusion values determined by each instrument shows a strong positive correlation, r2=0.86 (n=63). Each instrument's output also correlated significantly with the clinical grading of the scar, indicating the expected decrease in perfusion as the clinical condition of the scars improved with time. SIGNIFICANCE The new LSPI instrument compared favorably with the established LDI instrument, yielding similar results. The considerably faster scan time and higher resolution of the LSPI method provides a distinct clinical advantage, both in terms of patient comfort and for reliably matching perfusion characteristics to their associated anatomical features. The fast temporal response of the LSPI instrument could be used to monitor near real-time responses to mechanical or pharmacological interventions to study dynamic vascular changes to burn damaged tissues.
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Affiliation(s)
- C J Stewart
- McCaig Centre for Joint Injury and Arthritis Research, Department of Surgery, University of Calgary, 3330 Hospital Drive NW, Calgary, Alta., Canada T2N 4N1
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12
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Abstract
Optimal treatment of burn victims requires deep understanding of the profound pathophysiological changes occurring locally and systemically after injury. Accurate estimation of burn size and depth, as well as early resuscitation, is essential. Good burn care includes also cleansing, debridement, and prevention of sepsis. Wound healing, is of major importance to the survival and clinical outcome of burn patients. An ideal therapy would not only promote rapid healing but would also act as an antiscarring therapy. The present article is a literature review of the most up-to-date modalities applied to burn treatment without overlooking the numerous controversies that still persist.
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Affiliation(s)
- Bishara S Atiyeh
- Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center on Burns and Fire Disasters, Beirut, Lebanon.
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13
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Pierce MC, Sheridan RL, Hyle Park B, Cense B, de Boer JF. Collagen denaturation can be quantified in burned human skin using polarization-sensitive optical coherence tomography. Burns 2004; 30:511-7. [PMID: 15302415 DOI: 10.1016/j.burns.2004.02.004] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2004] [Indexed: 10/26/2022]
Abstract
Quantifiable prognostic indicators are of considerable practical value following thermal injury. Collagen is a major component of the skin, and is known to undergo denaturation at the elevated temperatures associated with burns. The purpose of this study was to determine whether a recently developed, non-invasive imaging technique could detect and quantify collagen denaturation in burned human skin. Polarization-sensitive optical coherence tomography (PS-OCT) imaging was used to quantify collagen birefringence in normal human skin, and in skin excised from burn patients. Images were acquired and displayed in 1s, and demonstrated qualitative differences between normal and partial-thickness burned human skin. Birefringence loss due to thermal denaturation of collagen was quantified, with mean phase retardation rates for samples of 26 normal and 26 burned skin sites determined to be 0.401 +/- 0.020 and 0.249 +/- 0.017 degrees /microm, respectively (mean +/- S.E.M.), with this difference in sample means shown to be statistically significant (P < 0.000001). Analysis of the accuracy of the technique indicated that PS-OCT measurements may be made with resolution sufficient to distinguish between burns of varying severity. In conclusion, PS-OCT is capable of imaging and quantifying collagen denaturation in burned human skin, providing a new parameter against which post-injury outcome may be compared.
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Affiliation(s)
- Mark C Pierce
- Wellman Center for Photomedicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA.
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Jeng JC, Bridgeman A, Shivnan L, Thornton PM, Alam H, Clarke TJ, Jablonski KA, Jordan MH. Laser Doppler imaging determines need for excision and grafting in advance of clinical judgment: a prospective blinded trial. Burns 2004; 29:665-70. [PMID: 14556723 DOI: 10.1016/s0305-4179(03)00078-0] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Clinicians' judgment as to which burns require excision and grafting remains one aspect of burn care without objective measurements. This study presents a prospective, blinded trial to assess decision to operate by laser Doppler imaging (numerical criteria) versus the clinical judgment of an experienced burn surgeon. METHODS A number of 23 patients were enrolled in this prospective trial and 41 representative wounds of indeterminate depth were selected for observation. Daily determination of need to operate (burn depth) was made by a single burn surgeon. Laser Doppler imager (LDI) scans of the same wounds were simultaneously obtained, and not revealed to the clinician. Data analysis compared quickness of decision to operate by LDI to the clinician's judgment. Concurrence of decisions by either method was compared. RESULTS A total of 23 patients and 41 wounds were analyzed. LDI and the surgeon agreed in determination of wound depth 56% of the time (23/41, P=0.031). Biopsy confirmation was obtained for 21 wounds. The surgeon's determination of burn depth was accurate in 71.4% of wounds biopsied (15/21). When the LDI scan median flux indicated need for excision, it was 100% accurate (7/7). When both the surgeon and the LDI were correct in assessing wound depth, LDI would have saved median number of 2 days (minimum=0, maximum=4). CONCLUSION LDI allowed for earlier, objective determination of need to operate. Concurrence with clinical judgment in this blinded study was excellent. LDI should be seen as an effective aid to clinical judgment when contemplating excision of burns with indeterminate depth.
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Affiliation(s)
- J C Jeng
- The Burn Center, MedStar Research Institute, Washington, DC, USA.
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Pape SA, Skouras CA, Byrne PO. An audit of the use of laser Doppler imaging (LDI) in the assessment of burns of intermediate depth. Burns 2001; 27:233-9. [PMID: 11311516 DOI: 10.1016/s0305-4179(00)00118-2] [Citation(s) in RCA: 222] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This is the first report of an evaluation of the use of a laser Doppler imager (LDI) scanner in the assessment of burn depth in patients. It is based on a 6-month, prospective audit of 76 burns of intermediate depth. Clinical and LDI assessments of burn wound depth were recorded at 48-72 h post-injury. Histological confirmation of depth was obtained from those burns requiring surgery. A healing time of less than 21 days was taken as confirmation of the injury being an superficial dermal burn. The accuracy of LDI in the assessment of burn depth was 97%, compared with 60-80% for established clinical methods. This audit confirms that LDI is a very accurate measurement tool for the assessment of burn wound depth. We recommend that all burns of intermediate depth should be analysed in this way in order to ensure appropriate management of the burn, to avoid unnecessary surgery and to reduce hospital stay and costs.
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Affiliation(s)
- S A Pape
- Royal Victoria Infirmary, NE1 4LP, Newcastle upon Tyne, UK
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