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Owoso T, Kankam HKN, Abdulsalam A, Lewis D. The Use of Laser Doppler Imaging in Nitric Acid Burns: A Case Report and Literature Review. J Burn Care Res 2023; 44:1440-1444. [PMID: 36987869 PMCID: PMC10628518 DOI: 10.1093/jbcr/irad044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Indexed: 03/30/2023]
Abstract
Laser Doppler imaging (LDI) technology has been validated to assess thermal burn depth by predicting wound healing potential. However, there is no clear evidence for its use in chemical burns. We present a case of an 8% total burn surface area (TBSA) nitric acid burn following an industrial accident, in an otherwise healthy 36-year-old man. LDI assessment was suggestive of poor healing potential of >21 days, warranting surgical management. However, conservative management was opted for based on clinical assessment as the wound eschar appeared thin and more consistent with epithelial staining. Patient follow-up confirmed a total burn healing time of two months, suggesting that the LDI assessment was accurate. A comprehensive literature review was performed using the MEDLINE (PubMed) database to identify animal or clinical studies evaluating the efficacy of LDI in chemical burns. A qualitative synthesis of our findings is presented. We identified two experimental studies in porcine models with sulfur mustard burns, each confirming the accuracy of LDI assessment when compared to the histopathology findings. Limited experimental animal studies on the use of LDI suggest similar validity in chemical burns, and this correlates with the clinical outcome in this case. However, this alone is insufficient to prove its validity and define its role in the assessment of chemical burns. Clinical trials are required to further assess and define the parameters of LDI use and efficacy in this context.
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Affiliation(s)
- Toluwaniyin Owoso
- Department of Burns and Plastic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Hadyn K N Kankam
- Department of Burns and Plastic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Abdulrazak Abdulsalam
- Department of Burns and Plastic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Darren Lewis
- Department of Burns and Plastic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Etemad L, Moshiri M, Balali-Mood M. Advances in treatment of acute sulfur mustard poisoning - a critical review. Crit Rev Toxicol 2020; 49:191-214. [PMID: 31576778 DOI: 10.1080/10408444.2019.1579779] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Sulfur mustard (SM) is a blistering chemical warfare agent that was used during the World War I and in the Iraq-Iran conflict. The aim of this paper is to discuss and critically review the published results of experiments on the treatment of SM poisoning based on our clinical and research experience. The victims must remove from the contaminated zone immediately. The best solution for decontamination is large amounts of water, using neutral soap and 0.5% sodium hypochlorite. Severely intoxicated patients should be treated according to advanced life support protocols and intensive care therapy for respiratory disorders and the chemical burn. Sodium thiosulfate infusion (100-500 mg/kg/min) should be started up to 60 min after SM exposure. However, N-acetyle cysteine (NAC) is recommended, none of them acts as specific or effective antidote. The important protective and conservative treatment of SM-induced pulmonary injuries include humidified oxygen, bronchodilators, NAC as muculytic, rehydration, mechanical ventilation, appropriate antibiotics and respiratory physiotherapy as clinically indicated. Treatment of acute SM ocular lesions start with topical antibiotics; preferably sulfacetamide eye drop, continue with lubricants, and artificial tears. Treatment for cutaneous injuries include: moist dressing; preferably with silver sulfadiazine cream, analgesic, anti-pruritic, physically debridement, debridase, Laser debridement, followed by skin autologous split-thickness therapy as clinically indicated. The new suggested medications and therapeutic approaches include: anti-inflammatory agents, Niacinamide, Silibinin, Calmodulin antagonists, Clobetasol, full-thickness skin grafting for skin injuries; Doxycycline; Bevacizumab, and Colchicine for ocular injuries. Recommended compounds based on animal studies include Niacinamide, Aprotinin, des-aspartate-angiotensin-I, Gamma-glutamyltransferase, vitamin E, and vitamin D. In vitro studies revealed that Dimethylthiourea, L-nitroarginine, Methyl-ester, Sodium pyruvate, Butylated hydroxyanisole, ethacrynic acid, and macrolide antibiotics are effective. However, none of them, except macrolide antibiotics have been proved clinically. Avoidance of inappropriate polypharmacy is advisable.
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Affiliation(s)
- Leila Etemad
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences , Mashhad , Iran
| | - Mohammad Moshiri
- Medical Toxicology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences , Mashhad , Iran
| | - Mahdi Balali-Mood
- Medical Toxicology and Drug Abuse Research Center, Birjand University of Medical Sciences , Birjand , Iran
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3
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Hall CA, Lydon HL, Dalton CH, Chipman JK, Graham JS, Chilcott RP. The percutaneous toxicokinetics of Sulphur mustard in a damaged skin porcine model and the evaluation of WoundStat™ as a topical decontaminant. J Appl Toxicol 2017; 37:1036-1045. [DOI: 10.1002/jat.3453] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 01/12/2017] [Accepted: 01/17/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Charlotte A. Hall
- CBRN & Chemical Toxicological Research Group, Centre for Radiation; Chemical and Environmental Hazards, Health Protection Agency; Chilton UK
- School of BioSciences; University of Birmingham; Birmingham UK
| | - Helen L. Lydon
- CBRN & Chemical Toxicological Research Group, Centre for Radiation; Chemical and Environmental Hazards, Health Protection Agency; Chilton UK
- School of BioSciences; University of Birmingham; Birmingham UK
| | | | | | - John S. Graham
- Medical Toxicology Branch Analytical Toxicology Division; US Army Medical Research Institute of Chemical Defense; Aberdeen Proving Ground; MD 21010 USA
| | - Robert P. Chilcott
- CBRN & Chemical Toxicological Research Group, Centre for Radiation; Chemical and Environmental Hazards, Health Protection Agency; Chilton UK
- Research Centre for Topical Drug Delivery and Toxicology; University of Hertfordshire; Hatfield UK
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Andrews CJ, Kempf M, Kimble R, Cuttle L. Development of a Consistent and Reproducible Porcine Scald Burn Model. PLoS One 2016; 11:e0162888. [PMID: 27612153 PMCID: PMC5017633 DOI: 10.1371/journal.pone.0162888] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 08/30/2016] [Indexed: 01/19/2023] Open
Abstract
There are very few porcine burn models that replicate scald injuries similar to those encountered by children. We have developed a robust porcine burn model capable of creating reproducible scald burns for a wide range of burn conditions. The study was conducted with juvenile Large White pigs, creating replicates of burn combinations; 50°C for 1, 2, 5 and 10 minutes and 60°C, 70°C, 80°C and 90°C for 5 seconds. Visual wound examination, biopsies and Laser Doppler Imaging were performed at 1, 24 hours and at 3 and 7 days post-burn. A consistent water temperature was maintained within the scald device for long durations (49.8 ± 0.1°C when set at 50°C). The macroscopic and histologic appearance was consistent between replicates of burn conditions. For 50°C water, 10 minute duration burns showed significantly deeper tissue injury than all shorter durations at 24 hours post-burn (p ≤ 0.0001), with damage seen to increase until day 3 post-burn. For 5 second duration burns, by day 7 post-burn the 80°C and 90°C scalds had damage detected significantly deeper in the tissue than the 70°C scalds (p ≤ 0.001). A reliable and safe model of porcine scald burn injury has been successfully developed. The novel apparatus with continually refreshed water improves consistency of scald creation for long exposure times. This model allows the pathophysiology of scald burn wound creation and progression to be examined.
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Affiliation(s)
- Christine J. Andrews
- Centre for Children’s Burns and Trauma Research, The University of Queensland, Centre for Children’s Health Research, South Brisbane, Queensland, Australia
| | - Margit Kempf
- Centre for Children’s Burns and Trauma Research, The University of Queensland, Centre for Children’s Health Research, South Brisbane, Queensland, Australia
| | - Roy Kimble
- Centre for Children’s Burns and Trauma Research, The University of Queensland, Centre for Children’s Health Research, South Brisbane, Queensland, Australia
| | - Leila Cuttle
- Centre for Children’s Burns and Trauma Research, Queensland University of Technology, School of Biomedical Sciences, Institute of Health and Biomedical Innovation at Centre for Children's Health Research, South Brisbane, Queensland, Australia
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5
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Ghassemi P, Wang B, Wang J, Wang Q, Chen Y, Joshua Pfefer T. Evaluation of Mobile Phone Performance for Near-Infrared Fluorescence Imaging. IEEE Trans Biomed Eng 2016; 64:1650-1653. [PMID: 28113231 DOI: 10.1109/tbme.2016.2601014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We have investigated the potential for contrast-enhanced near-infrared fluorescence imaging of tissue on a mobile phone platform. Charge-coupled device- and phone-based cameras were used to image molded and three-dimensional-printed tissue phantoms, and an ex vivo animal model. Quantitative and qualitative evaluations of image quality demonstrate the viability of this approach and elucidate variations in performance due to wavelength, pixel color, and image processing.
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Affiliation(s)
- Pejhman Ghassemi
- Center for Devices and Radiological HealthFood and Drug Administration
| | - Bohan Wang
- Department of Electrical and Computer EngineeringUniversity of Maryland
| | - Jianting Wang
- Center for Devices and Radiological HealthFood and Drug Administration
| | - Quanzeng Wang
- Center for Devices and Radiological HealthFood and Drug Administration
| | - Yu Chen
- Fischell Department of BioengineeringUniversity of Maryland
| | - T Joshua Pfefer
- Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD, USA
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Thatcher JE, Squiers JJ, Kanick SC, King DR, Lu Y, Wang Y, Mohan R, Sellke EW, DiMaio JM. Imaging Techniques for Clinical Burn Assessment with a Focus on Multispectral Imaging. Adv Wound Care (New Rochelle) 2016; 5:360-378. [PMID: 27602255 DOI: 10.1089/wound.2015.0684] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 03/16/2016] [Indexed: 11/13/2022] Open
Abstract
Significance: Burn assessments, including extent and severity, are some of the most critical diagnoses in burn care, and many recently developed imaging techniques may have the potential to improve the accuracy of these evaluations. Recent Advances: Optical devices, telemedicine, and high-frequency ultrasound are among the highlights in recent burn imaging advancements. We present another promising technology, multispectral imaging (MSI), which also has the potential to impact current medical practice in burn care, among a variety of other specialties. Critical Issues: At this time, it is still a matter of debate as to why there is no consensus on the use of technology to assist burn assessments in the United States. Fortunately, the availability of techniques does not appear to be a limitation. However, the selection of appropriate imaging technology to augment the provision of burn care can be difficult for clinicians to navigate. There are many technologies available, but a comprehensive review summarizing the tissue characteristics measured by each technology in light of aiding clinicians in selecting the proper device is missing. This would be especially valuable for the nonburn specialists who encounter burn injuries. Future Directions: The questions of when burn assessment devices are useful to the burn team, how the various imaging devices work, and where the various burn imaging technologies fit into the spectrum of burn care will continue to be addressed. Technologies that can image a large surface area quickly, such as thermography or laser speckle imaging, may be suitable for initial burn assessment and triage. In the setting of presurgical planning, ultrasound or optical microscopy techniques, including optical coherence tomography, may prove useful. MSI, which actually has origins in burn care, may ultimately meet a high number of requirements for burn assessment in routine clinical use.
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Affiliation(s)
| | - John J. Squiers
- Spectral MD, Inc., Dallas, Texas
- Baylor Research Institute, Baylor Scott & White Health, Dallas, Texas
| | | | | | - Yang Lu
- Spectral MD, Inc., Dallas, Texas
| | | | | | | | - J. Michael DiMaio
- Spectral MD, Inc., Dallas, Texas
- Baylor Research Institute, Baylor Scott & White Health, Dallas, Texas
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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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The use of Versajet hydrosurgery system in the treatment of vesicant burn caused by sulphur mustard: a propos of one case. Burns 2009; 36:e44-8. [PMID: 19520516 DOI: 10.1016/j.burns.2009.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Accepted: 04/07/2009] [Indexed: 11/21/2022]
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9
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Miland ÅO, de Weerd L, Weum S, Mercer JB. Visualising skin perfusion in isolated human abdominal skin flaps using dynamic infrared thermography and indocyanine green fluorescence video angiography. EUROPEAN JOURNAL OF PLASTIC SURGERY 2008. [DOI: 10.1007/s00238-008-0280-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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