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Ji S, Xiao S, Xia Z. Consensus on the treatment of second-degree burn wounds (2024 edition). BURNS & TRAUMA 2024; 12:tkad061. [PMID: 38343901 PMCID: PMC10858447 DOI: 10.1093/burnst/tkad061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/29/2023] [Accepted: 12/08/2023] [Indexed: 02/21/2024]
Abstract
Second-degree burns are the most common type of burn in clinical practice and hard to manage. Their treatment requires not only a consideration of the different outcomes that may arise from the dressing changes or surgical therapies themselves but also an evaluation of factors such as the burn site, patient age and burn area. Meanwhile, special attention should be given to the fact that there is no unified standard or specification for the diagnosis, classification, surgical procedure, and infection diagnosis and grading of second-degree burn wounds. This not only poses great challenges to the formulation of clinical treatment plans but also significantly affects the consistency of clinical studies. Moreover, currently, there are relatively few guidelines or expert consensus for the management of second-degree burn wounds, and no comprehensive and systematic guidelines or specifications for the treatment of second-degree burns have been formed. Therefore, we developed the Consensus on the Treatment of Second-Degree Burn Wounds (2024 edition), based on evidence-based medicine and expert opinion. This consensus provides specific recommendations on prehospital first aid, nonsurgical treatment, surgical treatment and infection treatment for second-degree burns. The current consensus generated a total of 58 recommendations, aiming to form a standardized clinical treatment plan.
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Affiliation(s)
- Shizhao Ji
- Correspondence: Shizhao Ji, ; Shichu Xiao, ; Zhaofan Xia,
| | - Shichu Xiao
- Correspondence: Shizhao Ji, ; Shichu Xiao, ; Zhaofan Xia,
| | - Zhaofan Xia
- Correspondence: Shizhao Ji, ; Shichu Xiao, ; Zhaofan Xia,
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2
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Sasaki J, Matsushima A, Ikeda H, Inoue Y, Katahira J, Kishibe M, Kimura C, Sato Y, Takuma K, Tanaka K, Hayashi M, Matsumura H, Yasuda H, Yoshimura Y, Aoki H, Ishizaki Y, Isono N, Ueda T, Umezawa K, Osuka A, Ogura T, Kaita Y, Kawai K, Kawamoto K, Kimura M, Kubo T, Kurihara T, Kurokawa M, Kobayashi S, Saitoh D, Shichinohe R, Shibusawa T, Suzuki Y, Soejima K, Hashimoto I, Fujiwara O, Matsuura H, Miida K, Miyazaki M, Murao N, Morikawa W, Yamada S. Japanese Society for Burn Injuries (JSBI) Clinical Practice Guidelines for Management of Burn Care (3rd Edition). Acute Med Surg 2022; 9:e739. [PMID: 35493773 PMCID: PMC9045063 DOI: 10.1002/ams2.739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/29/2022] [Accepted: 02/03/2022] [Indexed: 01/28/2023] Open
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3
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The accuracy of burn depth diagnosis: Clinical assessment before and after enzymatic debridement. BURNS OPEN 2021. [DOI: 10.1016/j.burnso.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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4
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Claes KEY, Hoeksema H, Vyncke T, Verbelen J, De Coninck P, De Decker I, Monstrey S. Evidence Based Burn Depth Assessment Using Laser-Based Technologies: Where Do We Stand? J Burn Care Res 2021; 42:513-525. [PMID: 33128377 DOI: 10.1093/jbcr/iraa195] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Early clinical assessment of burn depth and associated healing potential (HP) remains extremely challenging, even for experienced surgeons. Inaccurate diagnosis often leads to prolonged healing times and unnecessary surgical procedures, resulting in incremental costs, and unfavorable outcomes. Laser Doppler imaging (LDI) is currently the most objective and accurate diagnostic tool to measure blood flow and its associated HP, the main predictor for a patient's long-term functional and aesthetic outcome. A systematic review was performed on non-invasive, laser-based methods for burn depth assessment using skin microcirculation measurements to determine time to healing: Laser Doppler flowmetry (LDF), LDI and laser speckle contrast imaging (LSCI). Important drawbacks of single point LDF measurements are direct contact with numerous small points on the wound bed and the need to carry out serial measurements over several days. LDI is a fast, "non-contact," single measurement tool allowing to scan large burned areas with a 96% accuracy. LDI reduces the number of surgeries, improves the functional and aesthetic outcome and is cost-effective. There is only limited evidence for the use of LSCI in burn depth assessment. LSCI still needs technical improvements and scientific validation, before it can be approved for reliable burn assessment. LDI has proven to be invaluable in determining the optimal treatment of a burn patient. For unclear reasons, LDI is still not routinely used in burn centers worldwide. Additional research is required to identify potential "barriers" for universal implementation of this evidence-based burn depth assessment tool.
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Affiliation(s)
- Karel E Y Claes
- Burn Center, Ghent University Hospital, Ghent, Belgium.,Department of Plastic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Henk Hoeksema
- Burn Center, Ghent University Hospital, Ghent, Belgium.,Department of Plastic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Tom Vyncke
- Department of Plastic Surgery, Ghent University Hospital, Ghent, Belgium
| | | | | | | | - Stan Monstrey
- Burn Center, Ghent University Hospital, Ghent, Belgium.,Department of Plastic Surgery, Ghent University Hospital, Ghent, Belgium
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5
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Burn Image Recognition of Medical Images Based on Deep Learning: From CNNs to Advanced Networks. Neural Process Lett 2021. [DOI: 10.1007/s11063-021-10459-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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6
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Stone R, Jockheck-Clark AR, Natesan S, Rizzo JA, Wienandt NA, Scott LL, Larson DA, Wall JT, Holik MA, Shaffer LJ, Park N, Jovanovic A, Tetens S, Roche ED, Shi L, Christy RJ. Enzymatic Debridement of Porcine Burn Wounds via a Novel Protease, SN514. J Burn Care Res 2020; 41:1015-1028. [PMID: 32615590 DOI: 10.1093/jbcr/iraa111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Necrotic tissue generated by a thermal injury is typically removed via surgical debridement. However, this procedure is commonly associated with blood loss and the removal of viable healthy tissue. For some patients and contexts such as extended care on the battlefield, it would be preferable to remove devitalized tissue with a nonsurgical debridement agent. In this paper, a proprietary debridement gel (SN514) was evaluated for the ability to debride both deep-partial thickness (DPT) and full-thickness burn wounds using an established porcine thermal injury model. Burn wounds were treated daily for 4 days and visualized with both digital imaging and laser speckle imaging. Strip biopsies were taken at the end of the procedure. Histological analyses confirmed a greater debridement of the porcine burn wounds by SN514 than the vehicle-treated controls. Laser speckle imaging detected significant increases in the perfusion status after 4 days of SN514 treatment on DPT wounds. Importantly, histological analyses and clinical observations suggest that SN514 gel treatment did not damage uninjured tissue as no edema, erythema, or inflammation was observed on intact skin surrounding the treated wounds. A blinded evaluation of the digital images by a burn surgeon indicated that SN514 debrided more necrotic tissue than the control groups after 1, 2, and 3 days of treatment. Additionally, SN514 gel was evaluated using an in vitro burn model that used human discarded skin. Treatment of human burned tissue with SN514 gel resulted in greater than 80% weight reduction compared with untreated samples. Together, these data demonstrate that SN514 gel is capable of debriding necrotic tissue and suggest that SN514 gel could be a useful option for austere conditions, such as military multi-domain operations and prolonged field care scenarios.
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Affiliation(s)
- Randolph Stone
- Department of Burn and Soft Tissue Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - Angela R Jockheck-Clark
- Department of Burn and Soft Tissue Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - Shanmugasundaram Natesan
- Department of Burn and Soft Tissue Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - Julie A Rizzo
- US Army Burn Center, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - Nathan A Wienandt
- Comparative Pathology, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - Laura L Scott
- Epidemiology and Biostatistics, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - David A Larson
- Department of Burn and Soft Tissue Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - John T Wall
- Department of Burn and Soft Tissue Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - Michelle A Holik
- Department of Burn and Soft Tissue Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - Lucy J Shaffer
- Department of Burn and Soft Tissue Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - Nancy Park
- Department of Burn and Soft Tissue Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - Aleksa Jovanovic
- US Army Burn Center, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - Shannon Tetens
- Department of Biologics and Regenerative Medicine, Sam Houston, Texas
| | - Eric D Roche
- Department of Biologics and Regenerative Medicine, Sam Houston, Texas
| | - Lei Shi
- Department of Biologics and Regenerative Medicine, Sam Houston, Texas
| | - Robert J Christy
- Department of Burn and Soft Tissue Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
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7
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Abazari M, Ghaffari A, Rashidzadeh H, Badeleh SM, Maleki Y. A Systematic Review on Classification, Identification, and Healing Process of Burn Wound Healing. INT J LOW EXTR WOUND 2020; 21:18-30. [PMID: 32524874 DOI: 10.1177/1534734620924857] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Because of the intrinsic complexity, the classification of wounds is important for the diagnosis, management, and choosing the correct treatment based on wound type. Generally, burn injuries are classified as a class of wounds in which injury is caused by heat, cold, electricity, chemicals, friction, or radiation. On the other hand, wound healing is a complex process, and understanding the biological trend of this process and differences in the healing process of different wounds could reduce the possible risk in many cases and greatly reduce the future damage to the injured tissue and other organs. The aim of this review is to provide a general perspective for the burn wound location among the other types of injuries and summarizing as well as highlighting the differences of these types of wounds with emphasizing on factors affecting thereof.
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Affiliation(s)
| | | | | | | | - Yaser Maleki
- Institute for Advanced Studies in Basic Sciences. Zanjan, Iran
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8
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Wang R, Zhao J, Zhang Z, Cao C, Zhang Y, Mao Y. Diagnostic Accuracy of Laser Doppler Imaging for the Assessment of Burn Depth: A Meta-analysis and Systematic Review. J Burn Care Res 2019; 41:619-625. [PMID: 31872859 DOI: 10.1093/jbcr/irz203] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Abstract
An overall assessment of the diagnostic value of laser Doppler imaging (LDI) to assess burn depth in patients is presented based on relevant studies. Both eligible research and relevant articles were identified through specific index searches of Embase, Cochrane, and PubMed databases. The latest study included was published in March 2019 and all eligible publications reported on cohort or cross-sectional research. All articles were tested for heterogeneity by using a suitable effect model to calculate amalgamative values of sensitivity, specificity, and the diagnostic odds ratio (DOR). Analyses of summary receiver operating characteristic (SROC) are given for burn depth values. After rigorous screening, 14 studies with a total cohort of 1,818 patients were chosen for the meta-analysis to explore the validity of LDI diagnosis to assess the depth of burns. The burn depth overall sensitivity for LDI was 91% (95% CI: 86–95%) and global specificity was 96% (95% CI: 92–98%). The overall positive likelihood ratio of LDI was 20.35 (95% CI: 10.71–38.69) and the overall negative likelihood ratio was 0.09 (95% CI: 0.05–0.15). The overall DOR was 152.93 (95% CI: 69.44–336.81) of LDI. The acreage under the SROC was not low for LDI (AUC = 0.98; 95% CI: 0.96–0.99). In conclusion, the present analysis reviewed the literature and meta-analysis of studies to validate LDI for the diagnosis of burn depth. The results indicated that LDI has a high accuracy for this diagnostic function.
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Affiliation(s)
- Ru Wang
- Department of Burns and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Juan Zhao
- Department of Burns and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhenyu Zhang
- Department of Burns and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chang Cao
- Department of Burns and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yange Zhang
- Department of Burns and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yu Mao
- Department of Pediatric, Sichuan Provincial People’s Hospital, Chengdu, China
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9
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Wang P, Cao Y, Yin M, Li Y, Lv S, Huang L, Zhang D, Luo Y, Wu J. Full-field burn depth detection based on near-infrared hyperspectral imaging and ensemble regression. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2019; 90:064103. [PMID: 31255006 DOI: 10.1063/1.5034503] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 05/28/2019] [Indexed: 06/09/2023]
Abstract
The accurate and instant diagnosis of burn severity is always the key point of optimal wound management and clinical treatment. However, the accuracy of burn depth assessment is low via visual inspection and lacks a quantitative measurement. In this work, a full-field burn depth detection system is proposed using the near-infrared hyperspectral imaging with the ensemble regression. The rotational feature subspace ensemble regression is introduced to establish a complex regression model between the hyperspectral imaging data and the burn depth. By the in vivo measurement of a porcine model, the method can get the average relative error about 7% for the burn depth measurement, which demonstrates that the proposed method can perform an accurate full-field assessment of burn depth and provide more practical references for clinicians.
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Affiliation(s)
- Pin Wang
- School of Microelectronics and Communication Engineering, Chongqing University, Chongqing 400044, China
| | - Yao Cao
- School of Microelectronics and Communication Engineering, Chongqing University, Chongqing 400044, China
| | - Meifang Yin
- Institute of Burn Research, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Yongming Li
- School of Microelectronics and Communication Engineering, Chongqing University, Chongqing 400044, China
| | - Shanshan Lv
- School of Microelectronics and Communication Engineering, Chongqing University, Chongqing 400044, China
| | - Lixian Huang
- Chinese Academy of Engineering Physics, Institute of Fluid Physics, Mianyang, Sichuan 621000, China
| | - Dayong Zhang
- Chinese Academy of Engineering Physics, Institute of Fluid Physics, Mianyang, Sichuan 621000, China
| | - Yongquan Luo
- Chinese Academy of Engineering Physics, Institute of Fluid Physics, Mianyang, Sichuan 621000, China
| | - Jun Wu
- Department of Burns, The First Affiliated Hospital Sun Yat-Sen University, Guangzhou 510080, China
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10
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11
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Classification of burn injury using Raman spectroscopy and optical coherence tomography: An ex-vivo study on porcine skin. Burns 2018; 45:659-670. [PMID: 30385061 DOI: 10.1016/j.burns.2018.10.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/16/2018] [Accepted: 10/04/2018] [Indexed: 11/20/2022]
Abstract
Accurate depth assessment of burn wounds is a critical task to provide the right treatment and care. Currently, laser Doppler imaging is able to provide better accuracy compared to the standard clinical evaluation. However, its clinical applicability is limited by factors like scanning distance, time, and cost. Precise diagnosis of burns requires adequate structural and functional details. In this work, we evaluated the combined potential of two non-invasive optical modalities, optical coherence tomography (OCT) and Raman spectroscopy (RS), to identify degrees of burn wounds (superficial partial-thickness (SPT), deep partial-thickness (DPT), and full-thickness (FT)). OCT provides morphological information, whereas, RS provides biochemical aspects. OCT images and Raman spectra were obtained from burns created on ex-vivo porcine skin. Algorithms were developed to segment skin region and extract textural features from OCT images, and derive spectral wave features from RS. These computed features were fed into machine learning classifiers for categorization of burns. Histological results obtained from trichrome staining were used as ground-truth. The combined performance of RS-OCT reported an overall average accuracy of 85% and ROC-AUC=0.94, in distinguishing the burn wounds. The significant performance on ex vivo skin motivates to assess the feasibility of combined RS-OCT in in vivo models.
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12
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A systematic review on the quality of measurement techniques for the assessment of burn wound depth or healing potential. Burns 2018; 45:261-281. [PMID: 29941159 DOI: 10.1016/j.burns.2018.05.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 03/28/2018] [Accepted: 05/17/2018] [Indexed: 11/22/2022]
Abstract
PURPOSE Reliable and valid assessment of burn wound depth or healing potential is essential to treatment decision-making, to provide a prognosis, and to compare studies evaluating different treatment modalities. The aim of this review was to critically appraise, compare and summarize the quality of relevant measurement properties of techniques that aim to assess burn wound depth or healing potential. METHODS A systematic literature search was performed using PubMed, EMBASE and Cochrane Library. Two reviewers independently evaluated the methodological quality of included articles using an adapted version of the Consensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. A synthesis of evidence was performed to rate the measurement properties for each technique and to draw an overall conclusion on quality of the techniques. RESULTS Thirty-six articles were included, evaluating various techniques, classified as (1) laser Doppler techniques; (2) thermography or thermal imaging; (3) other measurement techniques. Strong evidence was found for adequate construct validity of laser Doppler imaging (LDI). Moderate evidence was found for adequate construct validity of thermography, videomicroscopy, and spatial frequency domain imaging (SFDI). Only two studies reported on the measurement property reliability. Furthermore, considerable variation was observed among comparator instruments. CONCLUSIONS Considering the evidence available, it appears that LDI is currently the most favorable technique; thereby assessing burn wound healing potential. Additional research is needed into thermography, videomicroscopy, and SFDI to evaluate their full potential. Future studies should focus on reliability and measurement error, and provide a precise description of which construct is aimed to measure.
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13
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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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14
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Wang P, Cao Y, Yin M, Li Y, Wu J. A burn depth detection system based on near infrared spectroscopy and ensemble learning. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2017; 88:114302. [PMID: 29195365 DOI: 10.1063/1.4997121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Near infrared (NIR) spectroscopy can effectively detect the changes in the burned tissue. However, due to the complex relationship between the spectral signals and the burn depth, simple methods of data analysis are difficult to solve this problem effectively. Therefore, in this paper, a machine learning method is introduced into the NIR spectral signal analysis, which is used to establish the relationship between NIR spectral signals and burn depth. First, based on the intensity of the spectral signal and the diffuse reflection theory, the optical properties that can reflect the change of burned tissue are extracted. And then the chained-agent genetic algorithm (CAGA) optimized support vector regression (SVR) is applied to establish a regression model between the optical property parameters and burn depth. Finally, the porcine model was used for verification. The experimental results demonstrate that the proposed CAGA-SVR integrated inversion model with optical properties can perform accurate inversion of burn depth and provide a reference for doctors.
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Affiliation(s)
- Pin Wang
- College of Communication Engineering, Chongqing University, Chongqing 400044, China
| | - Yao Cao
- College of Communication Engineering, Chongqing University, Chongqing 400044, China
| | - Meifang Yin
- Institute of Burn Research, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Yongming Li
- College of Communication Engineering, Chongqing University, Chongqing 400044, China
| | - Jun Wu
- Department of Burns, The First Affiliated Hospital Sun Yat-Sen University, Guangzhou 510080, China
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15
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Gibson ALF, Bennett DD, Taylor LJ. Improving the histologic characterization of burn depth. J Cutan Pathol 2017. [DOI: 10.1111/cup.12991] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Angela L. F. Gibson
- Department of Surgery; University of Wisconsin School of Medicine and Public Health; Madison Wisconsin
| | - Daniel D. Bennett
- Department of Dermatology; University of Wisconsin School of Medicine and Public Health; Madison Wisconsin
| | - Lauren J. Taylor
- Department of Surgery; University of Wisconsin School of Medicine and Public Health; Madison Wisconsin
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16
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Diagnostic accuracy of laser Doppler imaging in burn depth assessment: Systematic review and meta-analysis. Burns 2016; 42:1369-1376. [DOI: 10.1016/j.burns.2016.03.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 02/18/2016] [Accepted: 03/17/2016] [Indexed: 12/31/2022]
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17
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Paluchowski LA, Nordgaard HB, Bjorgan A, Hov H, Berget SM, Randeberg LL. Can spectral-spatial image segmentation be used to discriminate experimental burn wounds? JOURNAL OF BIOMEDICAL OPTICS 2016; 21:101413. [PMID: 27228458 DOI: 10.1117/1.jbo.21.10.101413] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 04/28/2016] [Indexed: 05/04/2023]
Abstract
Hyperspectral imaging (HSI) is a noncontact and noninvasive optical modality emerging the field of medical research. The goal of this study was to determine the ability of HSI and image segmentation to discriminate burn wounds in a preclinical porcine model. A heated brass rod was used to introduce burn wounds of graded severity in a pig model and a sequence of hyperspectral data was recorded up to 8-h postinjury. The hyperspectral images were processed by an unsupervised spectral–spatial segmentation algorithm. Segmentation was validated using results from histology. The proposed algorithm was compared to K-means segmentation and was found superior. The obtained segmentation maps revealed separated zones within the burn sites, indicating a variation in burn severity. The suggested image-processing scheme allowed mapping dynamic changes of spectral properties within the burn wounds over time. The results of this study indicate that unsupervised spectral–spatial segmentation applied on hyperspectral images can discriminate burn injuries of varying severity.
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Affiliation(s)
- Lukasz A Paluchowski
- Norwegian University of Science and Technology, Faculty of Information Technology, Department of Electronics and Telecommunications, Mathematics and Electrical Engineering, NTNU, Trondheim 7491, Norway
| | - Håvard B Nordgaard
- Trondheim University Hospital, St. Olavs Hospital, Department of Plastic Surgery, Trondheim 7030, Norway
| | - Asgeir Bjorgan
- Norwegian University of Science and Technology, Faculty of Information Technology, Department of Electronics and Telecommunications, Mathematics and Electrical Engineering, NTNU, Trondheim 7491, Norway
| | - Håkon Hov
- Trondheim University Hospital, St. Olavs Hospital, Department of Pathology and Medical Genetics, Trondheim 7030, NorwaydNorwegian University of Science and Technology, Faculty of Medicine, NTNU, Department of Laboratory Medicine, Children's and Women's He
| | - Sissel M Berget
- Trondheim University Hospital, St. Olavs Hospital, Department of Pathology and Medical Genetics, Trondheim 7030, Norway
| | - Lise L Randeberg
- Norwegian University of Science and Technology, Faculty of Information Technology, Department of Electronics and Telecommunications, Mathematics and Electrical Engineering, NTNU, Trondheim 7491, Norway
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18
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Cost-Effectiveness of Laser Doppler Imaging in Burn Care in The Netherlands: A Randomized Controlled Trial. Plast Reconstr Surg 2016; 137:166e-176e. [PMID: 26710049 DOI: 10.1097/prs.0000000000001900] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND In patients with burns, an early accurate diagnosis of burn depth facilitates optimal treatment. Laser Doppler imaging combined with clinical assessment leads to an accurate estimate of burn depth. However, the actual effects of the introduction of laser Doppler imaging on therapeutic decisions, clinical outcomes, and costs are unknown. METHODS A randomized controlled trial was conducted in the Dutch burn centers, including 202 patients with burns of indeterminate depth. In the standard care group, estimation of burn depth was based on clinical assessment only; in the laser Doppler imaging group, clinical assessment and laser Doppler imaging were combined. Primary outcome was time to wound healing. Furthermore, therapeutic decisions and cost-effectiveness were analyzed. RESULTS Mean time to wound healing was 14.3 days (95 percent CI, 12.8 to 15.9 days) in the laser Doppler imaging group and 15.5 days (95 percent CI, 13.9 to 17.2 days) in the standard care group (p = 0.258). On the day of randomization, clinicians decided significantly more often on operative or nonoperative treatment in the laser Doppler imaging group (p < 0.001), instead of postponing their treatment choice. Analyses in a subgroup of admitted patients requiring surgery showed a significant earlier decision for surgery and a shorter wound healing time in the laser Doppler imaging group. Mean total costs per patient were comparable in both groups. CONCLUSIONS Laser Doppler imaging improved therapeutic decisions. It resulted in a shorter wound healing time in the subgroup of admitted patients requiring surgery and has the potential for cost savings of €875 per scanned patient.
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19
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Hyperspectral Imaging for Burn Depth Assessment in an Animal Model. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 3:e591. [PMID: 26894016 PMCID: PMC4727700 DOI: 10.1097/gox.0000000000000558] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 10/09/2015] [Indexed: 11/26/2022]
Abstract
UNLABELLED Differentiating between superficial and deep-dermal (DD) burns remains challenging. Superficial-dermal burns heal with conservative treatment; DD burns often require excision and skin grafting. Decision of surgical treatment is often delayed until burn depth is definitively identified. This study's aim is to assess the ability of hyperspectral imaging (HSI) to differentiate burn depth. METHODS Thermal injury of graded severity was generated on the dorsum of hairless mice with a heated brass rod. Perfusion and oxygenation parameters of injured skin were measured with HSI, a noninvasive method of diffuse reflectance spectroscopy, at 2 minutes, 1, 24, 48 and 72 hours after wounding. Burn depth was measured histologically in 12 mice from each burn group (n = 72) at 72 hours. RESULTS Three levels of burn depth were verified histologically: intermediate-dermal (ID), DD, and full-thickness. At 24 hours post injury, total hemoglobin (tHb) increased by 67% and 16% in ID and DD burns, respectively. In contrast, tHb decreased to 36% of its original levels in full-thickness burns. Differences in deoxygenated and tHb among all groups were significant (P < 0.001) at 24 hours post injury. CONCLUSIONS HSI was able to differentiate among 3 discrete levels of burn injury. This is likely because of its correlation with skin perfusion: superficial burn injury causes an inflammatory response and increased perfusion to the burn site, whereas deeper burns destroy the dermal microvasculature and a decrease in perfusion follows. This study supports further investigation of HSI in early burn depth assessment.
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Demehri FR, Utter B, Freeman JJ, Fukatsu Y, Luntz J, Brei D, Teitelbaum DH. Development of an endoluminal intestinal attachment for a clinically applicable distraction enterogenesis device. J Pediatr Surg 2016; 51:101-6. [PMID: 26552895 PMCID: PMC4713322 DOI: 10.1016/j.jpedsurg.2015.10.026] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 10/07/2015] [Indexed: 01/17/2023]
Abstract
PURPOSE Previous methods of distraction enterogenesis have relied upon blind-ending intestinal segments or transmural device fixation, requiring multiple operations and potential bowel injury. We hypothesized that using a novel attachment would allow reversible device coupling to the luminal bowel surface, achieving effective endoluminal distraction. METHODS A telescopic hydraulic device was designed with latex balloon attachments covered with high-friction mesh and a dilating fenestrated elastic mask (DFM attachment), allowing mesh-to-mucosa contact only with inflation. Yorkshire pigs underwent jejunal Roux-en-Y limb creation and device placement via jejunostomy. Devices underwent 3 cycles of balloon inflation and hydraulic extension/retraction per day for 7 days and then explanted and studied for efficacy. RESULTS DFM attachment allowed reversible, high-strength endoluminal coupling without tissue injury or reduction in bowel perfusion. After 7 day implant, distracted bowel achieved a 44 ± 2% increase in length vs. fed, nondistracted bowel, corresponding to a gain of 7.1 ± 0.3 cm. Distracted bowel demonstrated increased epithelial cell proliferation vs. control bowel. Attachment sites demonstrated villus flattening, increased crypt depth, thicker muscularis mucosa, and unchanged muscularis propria thickness vs. CONCLUSION Novel high-strength, reversible attachments enabled fully endoluminal distraction enterogenesis, achieving length gains comparable to open surgical techniques. This approach may allow development of clinically applicable technology for SBS treatment.
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Affiliation(s)
- Farokh R Demehri
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, USA
| | - Brent Utter
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, USA
| | - Jennifer J Freeman
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, USA
| | - Yumi Fukatsu
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, USA
| | - Jonathan Luntz
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, USA
| | - Diann Brei
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, USA
| | - Daniel H Teitelbaum
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, USA.
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Infrared Thermal Imaging Has the Potential to Reduce Unnecessary Surgery and Delays to Necessary Surgery in Burn Patients. J Burn Care Res 2016; 37:350-355. [DOI: 10.1097/bcr.0000000000000330] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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22
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Ida T, Iwazaki H, Kawaguchi Y, Kawauchi S, Ohkura T, Iwaya K, Tsuda H, Saitoh D, Sato S, Iwai T. Burn depth assessments by photoacoustic imaging and laser Doppler imaging. Wound Repair Regen 2015; 24:349-55. [PMID: 26487320 DOI: 10.1111/wrr.12374] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 10/17/2015] [Indexed: 02/04/2023]
Abstract
Diagnosis of burn depths is crucial to determine the treatment plan for severe burn patients. However, an objective method for burn depth assessment has yet to be established, although a commercial laser Doppler imaging (LDI) system is used limitedly. We previously proposed burn depth assessment based on photoacoustic imaging (PAI), in which thermoelastic waves originating from blood under the burned tissue are detected, and we showed the validity of the method by experiments using rat models with three different burn depths: superficial dermal burn, deep dermal burn and deep burn. On the basis of those results, we recently developed a real-time PAI system for clinical burn diagnosis. Before starting a clinical trial, however, there is a need to reveal more detailed diagnostic characteristics, such as linearity and error, of the PAI system as well as to compare its characteristics with those of an LDI system. In this study, we prepared rat models with burns induced at six different temperatures from 70 to 98 °C, which showed a linear dependence of injury depth on the temperature. Using these models, we examined correlations of signals obtained by PAI and LDI with histologically determined injury depths and burn induction temperatures at 48 hours postburn. We found that the burn depths indicated by PAI were highly correlative with histologically determined injury depths (depths of viable vessels) as well as with burn induction temperatures. Perfusion values measured by LDI were less correlative with these parameters, especially for burns induced at higher temperatures, being attributable to the limited detectable depth for light involving a Doppler shift in tissue. In addition, the measurement errors in PAI were smaller than those in LDI. On the basis of these results, we will be able to start clinical studies using the present PAI system.
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Affiliation(s)
- Taiichiro Ida
- New Concept Product Initiative, Advantest Corporation
| | | | | | - Satoko Kawauchi
- Division of Biomedical Information Sciences, National Defense Medical College Research Institute
| | - Tsuyako Ohkura
- Division of Biomedical Information Sciences, National Defense Medical College Research Institute
| | - Keiichi Iwaya
- Department of Basic Pathology, National Defense Medical College Research Institute
| | - Hitoshi Tsuda
- Department of Basic Pathology, National Defense Medical College Research Institute
| | - Daizoh Saitoh
- Division of Basic Traumatology, National Defense Medical College Research Institute
| | - Shunichi Sato
- Division of Biomedical Information Sciences, National Defense Medical College Research Institute
| | - Toshiaki Iwai
- Graduate School of Bio-Applications and Systems Engineering, Tokyo University of Agriculture and Technology, Saitama, Japan
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Demehri FR, Freeman JJ, Fukatsu Y, Luntz J, Teitelbaum DH. Development of an endoluminal intestinal lengthening device using a geometric intestinal attachment approach. Surgery 2015; 158:802-11. [PMID: 26008962 DOI: 10.1016/j.surg.2015.03.055] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 03/30/2015] [Accepted: 03/31/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND Distraction enterogenesis may provide a novel therapy for short bowel syndrome. Previously described methods have relied on isolated intestinal segments or transmural fixation because of ineffective endoluminal attachment. We hypothesized that a novel approach of geometric coupling between a tapering device and the mesenteric curvature would allow trans-stomal distraction enterogenesis. METHODS A catheter device was designed with tapering stiffness, consisting of a stiff catheter with a taper to a flexible latex tip to prevent perforation. Yorkshire pigs underwent creation of a jejunal Roux limb with device placed via jejunostomy. Intestinal attachment was achieved without a substantial decrease in bowel perfusion as measured by laser Doppler. An external clamp was secured at the stoma to provide external fixation of the device. The catheter was advanced 1 cm/day for either 7 or 14 days before explant. RESULTS After 7 days, the distracted segment achieved a mean ± SD increase in length of 37 ± 6% versus fed, nondistracted bowel, corresponding to an absolute gain of 10.6 ± 1.7 cm (1.5 cm/day). After 14 days, the Roux limb achieved an 80 ± 2% increase in length versus fed control bowel, corresponding to an absolute gain of 16.8 ± 3.0 cm (1.2 cm/day). No perforation or stoma-related complication occurred. CONCLUSION We describe a novel catheter device with tapering stiffness allowing for endoluminal distraction enterogenesis via geometric coupling. This approach may allow development of clinically applicable technology for the treatment of patients with short bowel syndrome.
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Affiliation(s)
- Farokh R Demehri
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Jennifer J Freeman
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Yumi Fukatsu
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Jonathan Luntz
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI
| | - Daniel H Teitelbaum
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI.
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Crouzet C, Nguyen JQ, Ponticorvo A, Bernal NP, Durkin AJ, Choi B. Acute discrimination between superficial-partial and deep-partial thickness burns in a preclinical model with laser speckle imaging. Burns 2015; 41:1058-63. [PMID: 25814299 DOI: 10.1016/j.burns.2014.11.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 10/24/2014] [Accepted: 11/25/2014] [Indexed: 11/26/2022]
Abstract
A critical need exists for a robust method that enables early discrimination between superficial-partial and deep-partial thickness burn wounds. In this study, we report on the use of laser speckle imaging (LSI), a simple, non-invasive, optical imaging modality, to measure acute blood flow dynamics in a preclinical burn model. We used a heated brass comb to induce burns of varying severity to nine rats and collected raw speckle reflectance images over the course of three hours after burn. We induced a total of 12 superficial-partial and 18 deep-partial thickness burn wounds. At 3h after burn we observed a 28% and 44% decrease in measured blood flow for superficial-partial and deep-partial thickness burns, respectively, and that these reductions were significantly different (p=0.00007). This preliminary data suggests the potential role of LSI in the clinical management of burn wounds.
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Affiliation(s)
- Christian Crouzet
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, CA 92612, United States; Department of Biomedical Engineering, University of California, Irvine, CA 92697, United States
| | - John Quan Nguyen
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, CA 92612, United States
| | - Adrien Ponticorvo
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, CA 92612, United States
| | - Nicole P Bernal
- Department of Surgery, University of California, Irvine, CA 92868, United States
| | - Anthony J Durkin
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, CA 92612, United States; Department of Surgery, University of California, Irvine, CA 92868, United States
| | - Bernard Choi
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, CA 92612, United States; Department of Biomedical Engineering, University of California, Irvine, CA 92697, United States; Department of Surgery, University of California, Irvine, CA 92868, United States; Edwards Lifesciences Center for Advanced Cardiovascular Technology, University of California, Irvine, CA 92697, United States.
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Baran U, Li Y, Choi WJ, Kalkan G, Wang RK. High resolution imaging of acne lesion development and scarring in human facial skin using OCT-based microangiography. Lasers Surg Med 2015; 47:231-8. [PMID: 25740313 DOI: 10.1002/lsm.22339] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVE Acne is a common skin disease that often leads to scarring. Collagen and other tissue damage from the inflammation of acne give rise to permanent skin texture and microvascular changes. In this study, we demonstrate the capabilities of optical coherence tomography-based microangiography in detecting high-resolution, three-dimensional structural, and microvascular features of in vivo human facial skin during acne lesion initiation and scar development. MATERIALS AND METHODS A real time swept source optical coherence tomography system is used in this study to acquire volumetric images of human skin. The system operates on a central wavelength of 1,310 nm with an A-line rate of 100 kHz, and with an extended imaging range (∼12 mm in air). The system uses a handheld imaging probe to image acne lesion on a facial skin of a volunteer. We utilize optical microangiography (OMAG) technique to evaluate the changes in microvasculature and tissue structure. RESULTS Thanks to the high sensitivity of OMAG, we are able to image microvasculature up to capillary level and visualize the remodeled vessels around the acne lesion. Moreover, vascular density change derived from OMAG measurement is provided as an alternative biomarker for the assessment of human skin diseases. In contrast to other techniques like histology or microscopy, our technique made it possible to image 3D tissue structure and microvasculature up to 1.5 mm depth in vivo without the need of exogenous contrast agents. CONCLUSIONS The presented results are promising to facilitate clinical trials aiming to treat acne lesion scarring, as well as other prevalent skin diseases, by detecting cutaneous blood flow and structural changes within human skin in vivo.
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Affiliation(s)
- Utku Baran
- Department of Bioengineering, University of Washington, Seattle, Washington; Department of Electrical Engineering, University of Washington, Seattle, Washington
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Wang H, Baran U, Wang RK. In vivo blood flow imaging of inflammatory human skin induced by tape stripping using optical microangiography. JOURNAL OF BIOPHOTONICS 2015; 8:265-72. [PMID: 24659511 PMCID: PMC4308563 DOI: 10.1002/jbio.201400012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 02/25/2014] [Accepted: 02/27/2014] [Indexed: 05/03/2023]
Abstract
Vasculature response is a hallmark for most inflammatory skin disorders. Tape stripping on human skin causes a minor inflammation which leads to changes in microvasculature. In this study, optical microangiography (OMAG), noninvasive volumetric microvasculature in vivo imaging method, has been used to track the vascular responses after tape stripping. Vessel density has been quantified and used to correlate with the degree of skin irritation. The proved capability of OMAG technique in visualizing the microvasculature network under inflamed skin condition can play an important role in clinical trials of treatment and diagnosis of inflammatory skin disorders.
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Affiliation(s)
- Hequn Wang
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Utku Baran
- Department of Electrical Engineering, University of Washington, Seattle, WA, USA
| | - Ruikang K. Wang
- Department of Bioengineering, University of Washington, Seattle, WA, USA
- Department of Electrical Engineering, University of Washington, Seattle, WA, USA
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Štětinský J, Klosová H, Kolářová H, Šalounová D, Bryjová I, Hledík S. The time factor in the LDI (Laser Doppler Imaging) diagnosis of burns. Lasers Surg Med 2015; 47:196-202. [DOI: 10.1002/lsm.22291] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Jiří Štětinský
- Burn Center; University Hospital Ostrava; 17. Listopadu 1790 708 52 Ostrava-Poruba Czech Republic
- Department of Medical Biophysics; Faculty of Medicine; Palacky University; Hněvotínská 3 Olomouc Czech Republic
| | - Hana Klosová
- Burn Center; University Hospital Ostrava; 17. Listopadu 1790 708 52 Ostrava-Poruba Czech Republic
| | - Hana Kolářová
- Department of Medical Biophysics; Faculty of Medicine; Palacky University; Hněvotínská 3 Olomouc Czech Republic
| | - Dana Šalounová
- Department of Mathematical Method in Economy; Faculty of Economy; Technical University of Ostrava; Sokolská 33 Ostrava Czech Republic
| | - Iveta Bryjová
- Department of Cybernetics and Biomedical Engineering; Faculty of Electrical Engineering and Computer Science; Technical University of Ostrava; 17. Listopadu 15/2172 708 33 Ostrava-Poruba Czech Republic
- Faculty of Medicine; University of Ostrava; Syllabova 19 703 00 Ostrava Czech Republic
| | - Stanislav Hledík
- Institute of Physics; Silesian University in Opava; Bezručovo nám. 13 746 01 Opava Czech Republic
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A novel double-balloon catheter device for fully endoluminal intestinal lengthening. Pediatr Surg Int 2014; 30:1223-9. [PMID: 25319796 DOI: 10.1007/s00383-014-3612-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/07/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Distraction enterogenesis may provide a novel therapy for short bowel syndrome (SBS). Previously described methods have relied upon isolated intestinal segments or transmural fixation. Our objective was to develop a novel, fully endoluminal device, permitting placement and removal through an enteral stoma or orifice. METHODS A flexible device was designed consisting of two latex balloons mounted on coaxial catheters. The inner catheter allowed longitudinal force transmission from an external spring. Yorkshire pigs underwent jejunal Roux limb creation with device placement via jejunostomy. Balloons were inflated to 52 mmHg without significant reduction in bowel perfusion as measured by laser Doppler. The device was explanted after 7 days. RESULTS Distracted bowel achieved an increase in length of 26.1 ± 6.1 % vs nondistracted fed bowel. As the device resided in unfed bowel, a 66.7 ± 14.5% increase vs unfed bowel was noted. These corresponded to a gain of 6.3 ± 2.3 cm (0.9 ± 0.3 cm/day) and 12.9 ± 7.6 cm (1.8 ± 1.1 cm/day), respectively. Attachment sites demonstrated occasional epithelial sloughing with no balloon-associated perforation. CONCLUSION A novel double-balloon catheter device allows for fully endoluminal distraction enterogenesis. This approach may allow development of clinically applicable technology for the treatment of patients with SBS.
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Immediate evaluation of neovascularization in a grafted bilayered artificial dermis using laser Doppler imaging. Ann Plast Surg 2014; 72:84-8. [PMID: 23241770 DOI: 10.1097/sap.0b013e3182590948] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND A bilayered artificial dermis is widely applied for skin defects. Its collagen sponge is biodegraded and replaced with dermis-like tissue after application. There is no reliable method for quantitatively evaluating the blood flow of artificial dermis. In this study, we used laser Doppler imaging to evaluate the perfusion of artificial dermis. MATERIALS AND METHODS Twelve patients treated with artificial dermis and secondary skin grafting were included. We measured the perfusion unit just after application of artificial dermis, 1 week after, and before skin grafting. RESULTS Secondary skin grafts of 6 patients took completely, and the others showed partial necrosis. Laser Doppler imaging could detect blood flow in the artificial dermis, and a significant difference was observed in perfusion units between the "complete take" group and "partial necrosis" group before grafting (P < 0.05). CONCLUSIONS Laser Doppler imaging could be a useful and noninvasive technique for the evaluation of blood flow to the artificial dermis before grafting.
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A systematic review of the evolution of laser Doppler techniques in burn depth assessment. PLASTIC SURGERY INTERNATIONAL 2014; 2014:621792. [PMID: 25180087 PMCID: PMC4142313 DOI: 10.1155/2014/621792] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 06/19/2014] [Indexed: 12/25/2022]
Abstract
Aims. The introduction of laser Doppler (LD) techniques to assess burn depth has revolutionized the treatment of burns of indeterminate depth. This paper will systematically review studies related to these two techniques and trace their evolution. At the same time we hope to highlight current controversies and areas where further research is necessary with regard to LD imaging (LDI) techniques. Methods. A systematic search for relevant literature was carried out on PubMed, Medline, EMBASE, and Google Scholar. Key search terms included the following: “Laser Doppler imaging,” “laser Doppler flow,” and “burn depth.” Results. A total of 53 studies were identified. Twenty-six studies which met the inclusion/exclusion criteria were included in the review. Conclusions. The numerous advantages of LDI over those of LD flowmetry have resulted in the former technique superseding the latter one. Despite the presence of alternative burn depth assessment techniques, LDI remains the most favoured. Various newer LDI machines with increasingly sophisticated methods of assessing burn depth have been introduced throughout the years. However, factors such as cost effectiveness, scanning of topographically inconsistent areas of the body, and skewing of results due to tattoos, peripheral vascular disease, and anaemia continue to be sighted as obstacles to LDI which require further research.
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Mazhar A, Saggese S, Pollins AC, Cardwell NL, Nanney L, Cuccia DJ. Noncontact imaging of burn depth and extent in a porcine model using spatial frequency domain imaging. JOURNAL OF BIOMEDICAL OPTICS 2014; 19:086019. [PMID: 25147961 PMCID: PMC4141219 DOI: 10.1117/1.jbo.19.8.086019] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 07/28/2014] [Indexed: 05/05/2023]
Abstract
The standard of care for clinical assessment of burn severity and extent lacks a quantitative measurement. In this work, spatial frequency domain imaging (SFDI) was used to measure 48 thermal burns of graded severity (superficial partial, deep partial, and full thickness) in a porcine model. Functional (total hemoglobin and tissue oxygen saturation) and structural parameters (tissue scattering) derived from the SFDI measurements were monitored over 72 h for each burn type and compared to gold standard histological measurements of burn depth. Tissue oxygen saturation (stO₂) and total hemoglobin (ctHbT) differentiated superficial partial thickness burns from more severe burn types after 2 and 72 h, respectively (p < 0.01), but were unable to differentiate deep partial from full thickness wounds in the first 72 h. Tissue scattering parameters separated superficial burns from all burn types immediately after injury (p < 0.01), and separated all three burn types from each other after 24 h (p < 0.01). Tissue scattering parameters also showed a strong negative correlation to histological burn depth as measured by vimentin immunostain (r² > 0.89). These results show promise for the use of SFDI-derived tissue scattering as a correlation to burn depth and the potential to assess burn depth via a combination of SFDI functional and structural parameters.
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Affiliation(s)
- Amaan Mazhar
- Modulated Imaging Inc., Beckman Laser Institute Photonic Incubator, 1002 Health Sciences Road, Irvine, California 92617, United States
- Address all correspondence to: Amaan Mazhar, E-mail:
| | - Steve Saggese
- Modulated Imaging Inc., Beckman Laser Institute Photonic Incubator, 1002 Health Sciences Road, Irvine, California 92617, United States
| | - Alonda C. Pollins
- Vanderbilt University, Department of Plastic Surgery, Cell and Developmental Biology, Nashville, Tennessee 37232, United States
| | - Nancy L. Cardwell
- Vanderbilt University, Department of Plastic Surgery, Cell and Developmental Biology, Nashville, Tennessee 37232, United States
| | - Lillian Nanney
- Vanderbilt University, Department of Plastic Surgery, Cell and Developmental Biology, Nashville, Tennessee 37232, United States
| | - David J. Cuccia
- Modulated Imaging Inc., Beckman Laser Institute Photonic Incubator, 1002 Health Sciences Road, Irvine, California 92617, United States
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Mazhar A, Saggese S, Pollins AC, Cardwell NL, Nanney L, Cuccia DJ. Noncontact imaging of burn depth and extent in a porcine model using spatial frequency domain imaging. JOURNAL OF BIOMEDICAL OPTICS 2014; 19:020901. [PMID: 24525825 DOI: 10.1117/1.jbo.19.2.020901] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 12/20/2013] [Indexed: 05/02/2023]
Abstract
The standard of care for clinical assessment of burn severity and extent lacks a quantitative measurement. In this work, spatial frequency domain imaging (SFDI) was used to measure 48 thermal burns of graded severity (superficial partial, deep partial, and full thickness) in a porcine model. Functional (total hemoglobin and tissue oxygen saturation) and structural parameters (tissue scattering) derived from the SFDI measurements were monitored over 72 h for each burn type and compared to gold standard histological measurements of burn depth. Tissue oxygen saturation (stO₂) and total hemoglobin (ctHbT) differentiated superficial partial thickness burns from more severe burn types after 2 and 72 h, respectively (p < 0.01), but were unable to differentiate deep partial from full thickness wounds in the first 72 h. Tissue scattering parameters separated superficial burns from all burn types immediately after injury (p < 0.01), and separated all three burn types from each other after 24 h (p < 0.01). Tissue scattering parameters also showed a strong negative correlation to histological burn depth as measured by vimentin immunostain (r² > 0.89). These results show promise for the use of SFDI-derived tissue scattering as a correlation to burn depth and the potential to assess burn depth via a combination of SFDI functional and structural parameters.
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Affiliation(s)
- Amaan Mazhar
- Modulated Imaging Inc., Beckman Laser Institute Photonic Incubator, 1002 Health Sciences Road, Irvine, California 92617, United States
| | - Steve Saggese
- Modulated Imaging Inc., Beckman Laser Institute Photonic Incubator, 1002 Health Sciences Road, Irvine, California 92617, United States
| | - Alonda C Pollins
- Vanderbilt University, Department of Plastic Surgery, Cell and Developmental Biology, Nashville, Tennessee 37232, United States
| | - Nancy L Cardwell
- Vanderbilt University, Department of Plastic Surgery, Cell and Developmental Biology, Nashville, Tennessee 37232, United States
| | - Lillian Nanney
- Vanderbilt University, Department of Plastic Surgery, Cell and Developmental Biology, Nashville, Tennessee 37232, United States
| | - David J Cuccia
- Modulated Imaging Inc., Beckman Laser Institute Photonic Incubator, 1002 Health Sciences Road, Irvine, California 92617, United States
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Morimoto N, Kakudo N, Valentin Notodihardjo P, Suzuki S, Kusumoto K. Comparison of neovascularization in dermal substitutes seeded with autologous fibroblasts or impregnated with bFGF applied to diabetic foot ulcers using laser Doppler imaging. J Artif Organs 2014; 17:352-7. [DOI: 10.1007/s10047-014-0782-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 06/23/2014] [Indexed: 01/13/2023]
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Ganapathy P, Tamminedi T, Qin Y, Nanney L, Cardwell N, Pollins A, Sexton K, Yadegar J. Dual-imaging system for burn depth diagnosis. Burns 2014; 40:67-81. [DOI: 10.1016/j.burns.2013.05.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 05/05/2013] [Accepted: 05/07/2013] [Indexed: 12/28/2022]
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Pan SC. Burn blister fluids in the neovascularization stage of burn wound healing: A comparison between superficial and deep partial-thickness burn wounds. BURNS & TRAUMA 2013; 1:27-31. [PMID: 27574619 PMCID: PMC4994503 DOI: 10.4103/2321-3868.113332] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Burn wound healing is a complex and dynamic process that involves the interaction between different cell types and mediators. Neovascularization is an imperative stage of wound healing and consists of not only angiogenesis but also adult vasculogenesis. A superficial partial-thickness burn (SPTB) heals within 2 weeks without scarring. A deep partial-thickness burn (DPTB), conversely, requires 2 weeks or longer to heal and requires an aggressive treatment to prevent hypertrophic scarring. Burn blisters on the skin are a hallmark of not only SPTB but also DPTB; however, the effect of burn blister fluids on the neovascularization in these types of burns has not been fully explored. To verify this effect, the role of different burn fluids and the angiogenic factors that modulate this process are currently under investigation.
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Affiliation(s)
- Shin-Chen Pan
- Department of Surgery, Section of Plastic and Reconstructive Surgery, National Cheng Kung University Medical College and Hospital, 138 Sheng Li RD, Tainan
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Hop MJ, Hiddingh J, Stekelenburg C, Kuipers HC, Middelkoop E, Nieuwenhuis MK, Polinder S, van Baar ME. Cost-effectiveness of laser Doppler imaging in burn care in the Netherlands. BMC Surg 2013; 13:2. [PMID: 23369360 PMCID: PMC3574826 DOI: 10.1186/1471-2482-13-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 01/24/2013] [Indexed: 01/28/2023] Open
Abstract
Background Early accurate assessment of burn depth is important to determine the optimal treatment of burns. The method most used to determine burn depth is clinical assessment, which is the least expensive, but not the most accurate. Laser Doppler imaging (LDI) is a technique with which a more accurate (>95%) estimate of burn depth can be made by measuring the dermal perfusion. The actual effect on therapeutic decisions, clinical outcomes and the costs of the introduction of this device, however, are unknown. Before we decide to implement LDI in Dutch burn care, a study on the effectiveness and cost-effectiveness of LDI is necessary. Methods/design A multicenter randomised controlled trial will be conducted in the Dutch burn centres: Beverwijk, Groningen and Rotterdam. All patients treated as outpatient or admitted to a burn centre within 5 days post burn, with burns of indeterminate depth (burns not obviously superficial or full thickness) and a total body surface area burned of ≤ 20% are eligible. A total of 200 patients will be included. Burn depth will be diagnosed by both clinical assessment and laser Doppler imaging between 2–5 days post burn in all patients. Subsequently, patients are randomly divided in two groups: ‘new diagnostic strategy’ versus ‘current diagnostic strategy’. The results of the LDI-scan will only be provided to the treating clinician in the ‘new diagnostic strategy’ group. The main endpoint is the effect of LDI on wound healing time. In addition we measure: a) the effect of LDI on other patient outcomes (quality of life, scar quality), b) the effect of LDI on diagnostic and therapeutic decisions, and c) the effect of LDI on total (medical and non-medical) costs and cost-effectiveness. Discussion This trial will contribute to our current knowledge on the use of LDI in burn care and will provide evidence on its cost-effectiveness. Trial registration NCT01489540
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Affiliation(s)
- M Jenda Hop
- Association of Dutch Burn Centres, Red Cross Hospital, Beverwijk, the Netherlands
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Reprint of: Burn wound healing time assessed by laser Doppler imaging. Part 2: Validation of a dedicated colour code for image interpretation. Burns 2012; 38:195-202. [DOI: 10.1016/j.burns.2012.01.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2010] [Indexed: 11/21/2022]
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Pape S, Baker R, Wilson D, Hoeksema H, Jeng J, Spence R, Monstrey S. Burn wound healing time assessed by laser Doppler imaging (LDI). Part 1: Derivation of a dedicated colour code for image interpretation. Burns 2012; 38:187-94. [DOI: 10.1016/j.burns.2010.11.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Revised: 10/29/2010] [Accepted: 11/06/2010] [Indexed: 10/15/2022]
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Early depth assessment of local burns by videomicroscopy: a novel proposed classification. Burns 2012; 38:371-7. [PMID: 22284389 DOI: 10.1016/j.burns.2011.08.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2011] [Revised: 08/04/2011] [Accepted: 08/29/2011] [Indexed: 11/22/2022]
Abstract
PURPOSE Videomicroscopy is very useful for burn depth assessment in an early phase; however, there is no practical classification that includes complicated anatomic, pathologic, and morphologic findings of burn wounds. The aim of this study was to propose a novel classification to assess burn depth in its early phase easily and reliably by videomicroscopy. METHODS Forty-four patients with 56 intermediate-depth burn wounds were included. Burn depth was divided into each grade according to our proposed classification, which is composed of five categories based on dermal capillary integrity patterns. The intrarater and interrater reliabilities of the assessment by the second and third authors were evaluated by Cohen's unweighted κ-value. RESULTS The results of the measurements according to the proposed classification showed an accuracy of 92.9%, sensitivity of 81.8%, and specificity of 100.0%. The intrarater reliability of the second and third authors showed substantial agreement (κ=0.719 and 0.729, respectively). The interrater reliability of the sum of each observer's variable also showed substantial agreement (κ=0.636). CONCLUSION This pattern analysis system is easy to use even for inexperienced personnel, and is reliable with high accuracy and specificity. Intrarater and interrater statistics also support its reliability and reproducibility.
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Abstract
Hypertrophic scars are common complications of burn injury and other soft tissue injuries. Excessive extracellular matrix combined with inadequate remodeling of scar tissue results in an aesthetically and functionally unsatisfactory, painful, pruritic scar that can impair function. Treatment options are available to rehabilitation practitioners, but none are entirely satisfactory. An interdisciplinary clinical program is necessary for best outcomes. Challenges to be met by the rehabilitation community include research into the quantification of burn scar measurement, the effects of mechanical forces on wound healing and scar management, and the best combination of surgical, pharmacologic, and therapy interventions to maximize outcome from reconstructive procedures.
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Affiliation(s)
- Vincent Gabriel
- Division of Physical Medicine and Rehabilitation, Fire Fighters Burn Treatment Centre, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada.
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Meier T, Guggenheim M, Vetter S, Husmann M, Haile S, Amann-Vesti B. Microvascular regeneration in meshed skin transplants after severe burns. Burns 2011; 37:1010-4. [DOI: 10.1016/j.burns.2011.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2010] [Revised: 12/25/2010] [Accepted: 01/03/2011] [Indexed: 10/18/2022]
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Mihara K, Shindo H, Ohtani M, Nagasaki K, Nakashima R, Katoh N, Kishimoto S. Early depth assessment of local burns by videomicroscopy: 24 h after injury is a critical time point. Burns 2011; 37:986-93. [PMID: 21596478 DOI: 10.1016/j.burns.2011.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Revised: 01/28/2011] [Accepted: 03/12/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE Videomicroscopy has simple and prompt operability, and useful in the burn depth assessment in its early phase. A burn wound is, however, a dynamic environment in the first few days and the critical time to assess a burn wound by videomicroscopy has not been investigated. The aim of this study is to investigate the critical time point to assess the burn depth by videomicroscopy. METHODS Forty one patients with 44 intermediate depth burns admitted within 7 days after injury were included. Accuracies were assessed by comparison with clinical outcome: healing within 21 days after injury or not with conservative treatment. We prospectively evaluated and compared the accuracy of the videomicroscopy measurements with the clinical assessments. All findings were serialized in order of time after injury and divided into three groups, and we compared the appreciation of burn depth by videomicroscopy findings among groups. RESULTS The videomicroscopy measurements is significantly accurate compared with clinical assessments (p=0.001). The accuracy of videomicroscopy measurements was significantly lower in the post-injury <24 h group compared with post-injury ≥24 h group (p=0.004). CONCLUSION Videomicroscopy is effective tool in assessment of early burn depth and the critical time point to assess the burn depth by videomicroscopy is 24 h after injury.
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Burn wound healing time assessed by laser Doppler imaging. Part 2: Validation of a dedicated colour code for image interpretation. Burns 2011; 37:249-56. [PMID: 21084164 DOI: 10.1016/j.burns.2010.08.013] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Revised: 08/17/2010] [Accepted: 08/23/2010] [Indexed: 11/22/2022]
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Man or Machine? The Clinimetric Properties of Laser Doppler Imaging in Burn Depth Assessment. J Burn Care Res 2011; 32:143-9. [DOI: 10.1097/bcr.0b013e3182033346] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Critical review of burn depth assessment techniques: part II. Review of laser doppler technology. J Burn Care Res 2010; 31:151-7. [PMID: 20061851 DOI: 10.1097/bcr.0b013e3181c7ed60] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The judgment of which wounds are expected to heal within 21 days is one of the most difficult and important tasks of the burn surgeon. The quoted accuracy of 64 to 76% by senior burn surgeons underscores the importance of an adjunct technology to help make this determination. A plethora of techniques have been developed in the last 70 years. Laser Doppler imaging (LDI) is one of the most recent and widely studied of these techniques. The technology provides an estimate of perfusion through the burn wound, the assumption being that a lower perfusion correlates with a deeper wound and, therefore, a longer time to heal. Although some reports suggest accuracy between 96 and 100% and that it does this 2 days ahead of clinical judgment, others have questioned its applicability to clinical practice. This article, the second of a two-part series, has two objectives: 1) a review of the Doppler principle and how the LDI uses it to estimate perfusion; and 2) a critical assessment of the burn literature on the LDI. Part I provides a historical perspective of the different technologies used through the last 70 years to assist in the determination of burn depth. Laser Doppler has brought technology closer to provide a reliable adjuvant to the clinical prediction of healing, yet, caution is warranted. A clear understanding of the limitations of LDI is needed to put the current research in perspective to find the right clinical application for LDI.
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Burn imaging with a whole field laser Doppler perfusion imager based on a CMOS imaging array. Burns 2010; 36:389-96. [DOI: 10.1016/j.burns.2009.05.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Accepted: 05/01/2009] [Indexed: 11/19/2022]
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Pan SC, Wu LW, Chen CL, Shieh SJ, Chiu HY. Deep partial thickness burn blister fluid promotes neovascularization in the early stage of burn wound healing. Wound Repair Regen 2010; 18:311-8. [PMID: 20412554 DOI: 10.1111/j.1524-475x.2010.00586.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The effect of burn blister fluid in neovascularization during burn wound healing is unknown. Burn blister fluid, containing a large amount of chemokines, is thought to play a role in the early stage of neovascularization. This process includes angiogenesis and vasculogenesis. Because of different healing time of burn wounds, we hypothesized that neovascularization in superficial partial thickness burn (SPTB) and deep partial thickness burn (DPTB) wounds were different. The neovasculogenic effects of two different burn blister fluids were also different. We found Day 7 DPTB wounds had a significant increase in blood vessels compared with SPTB wounds by immunohistochemistry. DPTB blister fluid significantly promoted neovascularization via increasing endothelial cell proliferation, and migration and differentiation of circulating angiogenic cells relative to SPTB blister fluids. In the animal study, DPTB blister fluids markedly promoted new blood vessel formation compared with those from SPTB blister fluids using in vivo Matrigel plug assay. These results suggest that DPTB wounds require more new vessel formation than SPTB. Furthermore, the measurement of angiogenic activities in burn blister fluids serves as a possible tool for assessing burn wound status.
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Affiliation(s)
- Shin-Chen Pan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Cutaneous microcirculatory assessment of the burn wound is associated with depth of injury and predicts healing time. Burns 2009; 36:477-82. [PMID: 19854578 DOI: 10.1016/j.burns.2009.06.195] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2009] [Revised: 06/24/2009] [Accepted: 06/24/2009] [Indexed: 01/07/2023]
Abstract
RATIONALE Current trends for the treatment of deep partial thickness and full-thickness burns include early excision and skin grafting. In this study we retrospectively evaluated the ability of Laser Doppler Flowmetry (LDF), taken within 24h of the burn to predict: (1) burn wound depth and (2) wounds which would heal in less than 21 days. METHOD The Laser Doppler Flowmeter (O2C, LEA Medizintechnik, Germany) was employed to non-invasively measure the cutaneous microcirculation of 173 selected areas on 28 patients who suffered burns. RESULTS A distinct association between initial flow (<24h after burn injury) and the clinical assessment of depth of burn wounds was observed. Wounds demonstrating an initial blood flow of >100 AU were, in 93.1% of cases, correctly (positively) predicted for spontaneous healing within 21 days. A blood flow of <100 AU (negatively) predicted in 88.2%, those wounds which would not go on to heal within 21 days. Sequential measurement analysis (<24h, 3 days after injury and 6 days after injury) revealed no significant decrease in skin perfusion velocity or flow rate. CONCLUSION LDF can provide immediate results for early determination of burn wound depth and is useful in selecting patients for conservative treatment of their burn wounds.
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Altintas AA, Altintas MA, Ipaktchi K, Guggenheim M, Theodorou P, Theodorou P, Amini P, Spilker G. Assessment of microcirculatory influence on cellular morphology in human burn wound healing using reflectance-mode-confocal microscopy. Wound Repair Regen 2009; 17:498-504. [PMID: 19614915 DOI: 10.1111/j.1524-475x.2009.00516.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Previous studies have assessed the effects of changes in microcirculation on wound healing; however, the influence of microcirculation on tissue histomorphology remains widely unknown. Reflectance-mode-confocal microscopy (RMCM) enables in vivo tissue observation on a cellular level. We present RMCM data evaluating the local microcirculation and assess the influence on histomorphology during burn healing. RMCM was performed in 12 patients (aged; 36.2+/-14.2 years, maximum-burn-extent: 4% total body surface area) at times 12, 36, and 72 hours after a superficial burn. The following parameters were assessed: quantitative blood-cell-flow (cbf), epidermal thickness (Emin), basal-layer thickness (tbl), and granular cell-size (Agran). Cbf was found to be 54+/-3.6 cells/minutes (control), increased to 91+/-3.6 cells/minutes (p<0.05) 12 hours postburn; decreased to 71+/-6.1 cells/minutes (p<0.05) (36 hours), and to 63+/-2.3 cells/minutes (p>0.05) 72 hours postburn. Emin was 43.74+/-3.87 mum (control), increased to 51.67+/-4.04 mum (p<0.05) 12 hours, decreased to 48.67+/-3.51 mum (p<0.05) 36 hours, and to 45.33+/-3.21 mum (p>0.05) at 72 hours postburn. Tbl was 14.17+/-0.6 mum (control), increased to 16.93+/-1.15 mum (p<0.05) 12 hours, decreased to 15.93+/-1.20 mum (p<0.05) 32 hours, and to 15.00+/-0.85 mum (p>0.05) 72 hours postburn. Agran was 718+/-56.20 mum(2) (control), increased to 901+/-66.02 mum(2) (p<0.05) 12 hours, decreased to 826+/-56.86 mum(2) 36 hours, and 766+/-65.06 mum(2) at 72 hours postburn. RMCM enables in vivo observation of wound microcirculation and allows direct assessment of vascular effects on cutaneous histomorphology during the healing course of superficial burns.
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Affiliation(s)
- Ahmet Ali Altintas
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center Cologne, University of Witten Campus Cologne Merheim, 51109 Cologne, Germany.
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Cho JK, Moon DJ, Kim SG, Lee HG, Chung SP, Yoon CJ. Relationship between healing time and mean perfusion units of laser Doppler imaging (LDI) in pediatric burns. Burns 2009; 35:818-23. [DOI: 10.1016/j.burns.2008.12.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2008] [Revised: 12/15/2008] [Accepted: 12/18/2008] [Indexed: 10/20/2022]
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