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Casian D, Predenciuc A, Culiuc V. Clinical value of foot thermometry in patients with acute limb ischemia. Vascular 2024:17085381241237494. [PMID: 38426388 DOI: 10.1177/17085381241237494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
OBJECTIVE We hypothesized that the severity of foot poikilothermy can be used for better differentiation of grades of acute limb ischemia. Thus, the study aim was evaluation of the value of non-contact foot thermometry, performed using a low-cost infrared medical thermometer, as an adjunct for clinical diagnosis of immediately threatened acute limb ischemia. METHODS It was a single-center observational prospective study performed over 3 years. Patients with acute limb ischemia of lower limbs grade I-IIB Rutherford treated with urgent revascularization were included. Grade of ischemia was determined independently by two experienced vascular surgeons. Thermometry of the ischemic foot was performed using a medical digital infrared non-contact thermometer (CK-T1501, Cooligg, China) with measuring accuracy of ±0.2°C. Temperature was measured in three points: the dorsal surface of the foot, plantar surface of the foot (both in the metatarsal region), and forehead. The maximal temperature gradient between patient's forehead and foot (∆Tmax F-F) was calculated. Measurements were repeated 6-12 h after revascularization. RESULTS A total of 147 patients were included. Only 3 (2%) patients presented rest pain without sensory loss and motor deficit, while the majority were diagnosed with mild (63/147, 42.8%) or moderate (27/147, 18.3%) motor deficit. The temperature of the ischemic foot varied from 20 to 36.1°C, while median value of the temperature was 26.7 [24.5-29.9] °C on the dorsal surface and 26.8 [24.5-29.6] °C on the plantar surface of the foot (p = 0.85). Patients with Grade IIB ischemia had significantly lower dorsal foot temperature, plantar foot temperature, and larger ∆Tmax F-F than the patients with grades I-IIA: 25.1 [23.9-26.8] °C versus 29.9 [27.6-30.8] °C; 25.2 [23.8-27.5] °C versus 29.6 [28-31.1] °C; and 11.6 [9.7-12.8] °C versus 7.2 [6-9] °C (p < 0.0001). Areas under ROC curve for diagnosis of Grade IIB ischemia were similar for dorsal foot temperature (0.82), plantar temperature (0.81), and ∆Tmax F-F (0.82). The best cutoff value by Youden was ≥9.5°C for ∆Tmax F-F, ≤26.8°C for dorsal, and ≤27.7°C for plantar temperature. Criterion ∆Tmax F-F offered the highest specificity of 86% (95%CI 74.2-93.7) and positive predictive value of 89.2% (95%CI 79.5-93.2), while plantar temperature offered sensitivity of 82.5% (95%CI 70.1-91.3) and negative predictive value of 69.1% (95%CI 57.6-83.2). In multivariate analysis including age, gender, and etiology of arterial occlusion, the criterion ∆Tmax F-F of ≥9.5°C was a unique variable significantly associated with risk of amputation (adjusted OR 2.6, 95%CI 1.2-5.9, p = 0.01). CONCLUSION Current study demonstrated that patients with immediately threatening ALI have significantly lower foot temperature than those with viable and marginally threatened limbs. Severe foot poikilothermy at admission is associated with poor outcomes of revascularization, mostly with limb loss.
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Affiliation(s)
- Dumitru Casian
- Vascular Surgery Clinic, Department of General Surgery nr, 3, "Nicolae Testemitanu" State University of Medicine and Pharmacy, Chisinau, Moldova
- Division of Vascular Surgery, Institute of Emergency Medicine, Chisinau, Moldova
| | - Alexandru Predenciuc
- Vascular Surgery Clinic, Department of General Surgery nr, 3, "Nicolae Testemitanu" State University of Medicine and Pharmacy, Chisinau, Moldova
- Division of Vascular Surgery, Institute of Emergency Medicine, Chisinau, Moldova
| | - Vasile Culiuc
- Vascular Surgery Clinic, Department of General Surgery nr, 3, "Nicolae Testemitanu" State University of Medicine and Pharmacy, Chisinau, Moldova
- Division of Vascular Surgery, Institute of Emergency Medicine, Chisinau, Moldova
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Marques R, de Lopes MVO, Neves‐Amado JD, Ramos PAS, de Sá LO, da Oliveira IMS, da Amado JMC, de Vasconcelos MJM, Salgado PMF, Alves PJP. Integrating factors associated with complex wound healing into a mobile application: Findings from a cohort study. Int Wound J 2024; 21:e14339. [PMID: 37667542 PMCID: PMC10781894 DOI: 10.1111/iwj.14339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 09/06/2023] Open
Abstract
Complex, chronic or hard-to-heal wounds are a prevalent health problem worldwide, with significant physical, psychological and social consequences. This study aims to identify factors associated with the healing process of these wounds and develop a mobile application for wound care that incorporates these factors. A prospective multicentre cohort study was conducted in nine health units in Portugal, involving data collection through a mobile application by nurses from April to October 2022. The study followed 46 patients with 57 wounds for up to 5 weeks, conducting six evaluations. Healing time was the main outcome measure, analysed using the Mann-Whitney test and three Cox regression models to calculate risk ratios. The study sample comprised various wound types, with pressure ulcers being the most common (61.4%), followed by venous leg ulcers (17.5%) and diabetic foot ulcers (8.8%). Factors that were found to impair the wound healing process included chronic kidney disease (U = 13.50; p = 0.046), obesity (U = 18.0; p = 0.021), non-adherence to treatment (U = 1.0; p = 0.029) and interference of the wound with daily routines (U = 11.0; p = 0.028). Risk factors for delayed healing over time were identified as bone involvement (RR 3.91; p < 0.001), presence of odour (RR 3.36; p = 0.007), presence of neuropathy (RR 2.49; p = 0.002), use of anti-inflammatory drugs (RR 2.45; p = 0.011), stalled wound (RR 2.26; p = 0.022), greater width (RR 2.03; p = 0.002), greater depth (RR 1.72; p = 0.036) and a high score on the healing scale (RR 1.21; p = 0.001). Integrating the identified risk factors for delayed healing into the assessment of patients and incorporating them into a mobile application can enhance decision-making in wound care.
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Affiliation(s)
- Raquel Marques
- Centre for Interdisciplinary Research in HealthUniversidade Católica Portuguesa, Institute of Health SciencesPortoPortugal
| | | | - João Daniel Neves‐Amado
- Centre for Interdisciplinary Research in HealthUniversidade Católica Portuguesa, Institute of Health SciencesPortoPortugal
- School of Nursing DepartmentUniversidade Católica Portuguesa, Institute of Health SciencesPortoPortugal
| | - Paulo Alexandre Silva Ramos
- Centre for Interdisciplinary Research in HealthUniversidade Católica Portuguesa, Institute of Health SciencesPortoPortugal
- Unidade de Saúde Familiar Corino de AndradePortoPortugal
| | - Luís Octávio de Sá
- Centre for Interdisciplinary Research in HealthUniversidade Católica Portuguesa, Institute of Health SciencesPortoPortugal
- School of Nursing DepartmentUniversidade Católica Portuguesa, Institute of Health SciencesPortoPortugal
| | - Irene Maria Silva da Oliveira
- Centre for Interdisciplinary Research in HealthUniversidade Católica Portuguesa, Institute of Health SciencesPortoPortugal
- School of Nursing DepartmentUniversidade Católica Portuguesa, Institute of Health SciencesPortoPortugal
| | - João Manuel Costa da Amado
- Centre for Interdisciplinary Research in HealthUniversidade Católica Portuguesa, Institute of Health SciencesPortoPortugal
- School of Nursing DepartmentUniversidade Católica Portuguesa, Institute of Health SciencesPortoPortugal
| | | | | | - Paulo Jorge Pereira Alves
- Centre for Interdisciplinary Research in HealthUniversidade Católica Portuguesa, Institute of Health SciencesPortoPortugal
- School of Nursing DepartmentUniversidade Católica Portuguesa, Institute of Health SciencesPortoPortugal
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Marques R, Lopes M, Ramos P, Neves‐Amado J, Alves P. Prognostic factors for delayed healing of complex wounds in adults: A scoping review. Int Wound J 2023; 20:2869-2886. [PMID: 36916415 PMCID: PMC10410354 DOI: 10.1111/iwj.14128] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/08/2023] [Accepted: 02/13/2023] [Indexed: 03/15/2023] Open
Abstract
Complex or hard-to-heal wounds continue to be a challenge because of the negative impact they have on patients, caregivers, and all the associated costs. This study aimed to identify prognostic factors for the delayed healing of complex wounds. Five databases and grey literature were the sources used to research adults with pressure ulcers/injuries, venous leg ulcers, critical limb-threatening ischaemia, or diabetic foot ulcers and report the prognostic factors for delayed healing in all care settings. In the last 5 years, a total of 42 original peer-reviewed articles were deemed eligible for this scoping review that followed the JBI recommendations and checklist PRISMA-ScR. The most frequent prognostic factors found with statistical significance coinciding with various wound aetiologies were: gender (male), renal disease, diabetes, peripheral arterial disease, the decline in activities of daily life, wound duration, wound area, wound location, high-stage WIfI classification, gangrene, infection, previous ulcers, and low ankle brachial index. It will be essential to apply critical appraisal tools and assessment risk of bias to the included studies, making it possible to make recommendations for clinical practice and build prognostic models. Future studies are recommended because the potential for healing through identification of prognostic factors can be determined, thus allowing an appropriate therapeutic plan to be developed.
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Affiliation(s)
- Raquel Marques
- Centre for Interdisciplinary Research in Health, Instituto de Ciências da SaúdeUniversidade Católica PortuguesaPortoPortugal
| | - Marcos Lopes
- School of Nursing DepartmentUniversidade Federal CearáFortalezaBrazil
| | - Paulo Ramos
- Centre for Interdisciplinary Research in Health, Instituto de Ciências da SaúdeUniversidade Católica PortuguesaPortoPortugal
- Unidade de Saúde Familiar Corino de AndradePortoPortugal
| | - João Neves‐Amado
- Centre for Interdisciplinary Research in Health, Instituto de Ciências da SaúdeUniversidade Católica PortuguesaPortoPortugal
- School of Nursing DepartmentUniversidade Católica PortuguesaPortoPortugal
| | - Paulo Alves
- Centre for Interdisciplinary Research in Health, Instituto de Ciências da SaúdeUniversidade Católica PortuguesaPortoPortugal
- School of Nursing DepartmentUniversidade Católica PortuguesaPortoPortugal
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Crepaldi A, Caruso L, Piva G, Traina L, Gasbarro V, Manfredini R, Lamberti N, Rinaldo N, Manfredini F, Lopez-Soto PJ. Foot Temperature by Infrared Thermography in Patients with Peripheral Artery Disease before and after Structured Home-Based Exercise: A Gender-Based Observational Study. J Pers Med 2023; 13:1312. [PMID: 37763080 PMCID: PMC10532675 DOI: 10.3390/jpm13091312] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 08/21/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023] Open
Abstract
Decreased arterial perfusion is a typical condition of patients with peripheral artery disease (PAD), with the microvascular picture particularly present among women. This observational study aimed to detect foot perfusion changes by infrared thermography (IRT) after a home-based exercise program in both sexes. A total of 76 PAD patients with claudication (72 ± 4 years; 52 males) were enrolled in a structured in-home exercise program composed of two daily 8 min interval walking sessions (1:1 walk:rest ratio) with progressively increasing speed. Outcome measures collected at baseline (T0) and at each hospital visit after 5 weeks, 12 weeks and 20 weeks included foot temperature measured by IRT (anterior tibial, posterior tibial, dorsalis pedis and arcuate artery regions), ankle brachial index and the 6 min walking test. After 20 weeks, foot temperature in both limbs showed a significant increasing trend, with a mean variation of 1.3 °C for the more impaired limb and 0.9 °C for the contralateral limb (t = 8.88, p < 0.001 and t = 5.36; p < 0.001, respectively), with significant changes occurring after 5 weeks of training. The sex-oriented analysis did not highlight any significant difference, with an improvement of mean foot temperature of 1.5 ± 0.6 °C in females versus 1.2 ± 0.5 °C in males (p = 0.42). Ankle brachial index and performance also significantly improved over time (p < 0.001) without gender differences. In patients with PAD, a structured low-intensity exercise program significantly improved foot temperature and exercise capacity without any sex-related difference.
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Affiliation(s)
- Anna Crepaldi
- Department of Nursing, Instituto Maimónides de Investigación Biomédica de Córdoba, 14004 Cordoba, Spain; (A.C.); (P.J.L.-S.)
- Department of Nursing, Pharmacology and Physiotherapy, Universidad de Córdoba, 14004 Cordoba, Spain
- Department of Nursing, Hospital Universitario Reina Sofía de Córdoba, 14004 Cordoba, Spain
| | - Lorenzo Caruso
- Department of Environmental and Prevention Sciences, University of Ferrara, 44121 Ferrara, Italy;
| | - Giovanni Piva
- Department of Humanities, University of Ferrara, 44121 Ferrara, Italy;
| | - Luca Traina
- Unit of Vascular and Endovascular Surgery, University Hospital of Ferrara, 44124 Ferrara, Italy; (L.T.); (V.G.)
| | - Vincenzo Gasbarro
- Unit of Vascular and Endovascular Surgery, University Hospital of Ferrara, 44124 Ferrara, Italy; (L.T.); (V.G.)
- Department of Medical Sciences, University of Ferrara, 44124 Ferrara, Italy;
| | - Roberto Manfredini
- Department of Medical Sciences, University of Ferrara, 44124 Ferrara, Italy;
- University Center for Studies on Gender Medicine, University of Ferrara, 44121 Ferrara, Italy
| | - Nicola Lamberti
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (N.L.); (N.R.)
| | - Natascia Rinaldo
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (N.L.); (N.R.)
| | - Fabio Manfredini
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (N.L.); (N.R.)
- Program of Vascular Rehabilitation and Exercise Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Pablo Jesus Lopez-Soto
- Department of Nursing, Instituto Maimónides de Investigación Biomédica de Córdoba, 14004 Cordoba, Spain; (A.C.); (P.J.L.-S.)
- Department of Nursing, Pharmacology and Physiotherapy, Universidad de Córdoba, 14004 Cordoba, Spain
- Department of Nursing, Hospital Universitario Reina Sofía de Córdoba, 14004 Cordoba, Spain
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The Value of Infrared Thermography to Assess Foot and Limb Perfusion in Relation to Medical, Surgical, Exercise or Pharmacological Interventions in Peripheral Artery Disease: A Systematic Review. Diagnostics (Basel) 2022; 12:diagnostics12123007. [PMID: 36553014 PMCID: PMC9777328 DOI: 10.3390/diagnostics12123007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/11/2022] [Accepted: 11/25/2022] [Indexed: 12/05/2022] Open
Abstract
Infrared thermography (IRT) is a promising imaging method in patients with peripheral artery disease (PAD). This systematic review aims to provide an up-to-date overview of the employment of IRT as both a diagnostic method and an outcome measure in PAD patients in relation to any kind of intervention. On September 2022, MEDLINE, EMBASE, CENTRAL, Google Scholar, Web of Science, and gray literature were screened. Eligible articles employing IRT in PAD were screened for possible inclusion. The RoB 2.0 tool was used to assess the risk of bias. Twenty-one eligible articles were finally included, recruiting a total of 1078 patients. The IRT was used for PAD diagnosis/monitoring in 11 studies or to assess the effect of interventions (revascularization, pharmacological therapy, or exercise rehabilitation) in 10 studies. The analysis of the included papers raised high concerns about the overall quality of the studies. In conclusion, IRT as a noninvasive technique showed promising results in detecting foot perfusion in PAD patients. However, limits related to devices, points of reference, and measurement conditions need to be overcome by properly designed trials before recommending its implementation in current vascular practice.
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Ma KF, Nijboer TS, Kleiss SF, El Moumni M, Bokkers RPH, Schuurmann RCL, de Vries JPPM. Determination of Changes in Tissue Perfusion at Home with Hyperspectral and Thermal Imaging in the First Six Weeks after Endovascular Therapy in Patients with Peripheral Arterial Disease. Diagnostics (Basel) 2022; 12:diagnostics12102489. [PMID: 36292181 PMCID: PMC9600062 DOI: 10.3390/diagnostics12102489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/07/2022] [Accepted: 10/10/2022] [Indexed: 12/24/2022] Open
Abstract
The aims of this study were to assess changes in tissue perfusion up to 6 weeks after endovascular therapy (EVT), in hospital and at home, and to determine differences in tissue perfusion between patients with and without clinical improvement or good angiographic result. This single-center prospective cohort study included patients undergoing EVT for Rutherford stages two to six. Hyperspectral and thermal imaging were performed at the dorsal and plantar sides of the foot. These measurements consisted of a baseline measurement pre-EVT, and six follow-up measurements obtained at 1 and 4 h and 6 weeks in hospital, and 1 day, 7 days, and 14 days at home. Clinical improvement was defined as a decrease of one or more Rutherford class or decrease in the wound surface area and a good angiographic result was accomplished when a Transatlantic Inter-Society Consensus for the Management of PAD II C or D lesion was treated and uninterrupted flow continued in at least one below-the-knee artery in continuation with the inframalleolar arteries. The study included 34 patients with 41 treated limbs. Deoxyhemoglobin values were lower 1 h post-EVT compared with baseline and increased over time up to 6 weeks post-EVT. Significant differences in deoxyhemoglobin levels at 7 and 14 days post-EVT were determined between patients with and without clinical or angiographic success. This prospective pilot study shows the feasibility of hyperspectral imaging and thermal imaging post-EVT at home, which may decrease the need for hospital visits.
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Affiliation(s)
- Kirsten F. Ma
- Division of Vascular Surgery, Department of Surgery, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
- Correspondence:
| | - Thomas S. Nijboer
- Division of Vascular Surgery, Department of Surgery, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Simone F. Kleiss
- Division of Vascular Surgery, Department of Surgery, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Mostafa El Moumni
- Division of Trauma Surgery, Department of Surgery, University of Groningen, University Medical Center Groningen, 9712 CP Groningen, The Netherlands
| | - Reinoud P. H. Bokkers
- Department of Radiology, Medical Imaging Center, University of Groningen, University Medical Center Groningen, 9712 CP Groningen, The Netherlands
| | - Richte C. L. Schuurmann
- Division of Vascular Surgery, Department of Surgery, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Jean-Paul P. M. de Vries
- Division of Vascular Surgery, Department of Surgery, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
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Kleiss SF, Ma KF, El Moumni M, Ünlü Ç, Nijboer TS, Schuurmann RCL, Bokkers RPH, de Vries JPPM. Detecting Changes in Tissue Perfusion With Hyperspectral Imaging and Thermal Imaging Following Endovascular Treatment for Peripheral Arterial Disease. J Endovasc Ther 2022; 30:382-392. [PMID: 35255764 DOI: 10.1177/15266028221082013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE Hyperspectral imaging (HSI) and thermal imaging allow contact-free tissue perfusion measurements and may help determine the effect of endovascular treatment (EVT) in patients with peripheral arterial disease. This study aimed to detect changes in perfusion with HSI and thermal imaging peri-procedurally and determine whether these changes can identify limbs that show clinical improvement after 6 weeks. METHODS Patients with Rutherford class 2-6 scheduled for EVT were included prospectively. Hyperspectral imaging and thermal imaging were performed directly before and after EVT. Images were taken from the lateral side of the calves and plantar side of the feet. Concentrations of (de)oxyhemoglobin, oxygen saturation, and skin temperature were recorded. Angiographic results were determined on completion angiogram. Clinical improvement 6 weeks after EVT was defined as a decrease ≥ one Rutherford class. Peri-procedural changes in perfusion parameters were compared between limbs with and without good angiographic results or clinical improvement. To identify limbs with clinical improvement, receiver operating characteristic (ROC) curves were used to determine cutoff values for change in HSI. RESULTS Included were 23 patients with 29 treated limbs. Change in HSI values and temperature was not significantly different between limbs with good and poor angiographic results. Change in peri-procedural deoxyhemoglobin, determined by HSI, at the calves and feet was significantly different between limbs with and without clinical improvement at 6 week follow-up (p=0.027 and p=0.017, respectively). The ROC curve for change in deoxyhemoglobin at the calves showed a cutoff value of ≤1.0, and ≤-0.5 at the feet, which were discriminative for clinical improvement (sensitivity 77%; specificity 75% and sensitivity 62%; specificity 88%, respectively). CONCLUSIONS HSI can detect changes in perfusion at the calves after EVT in patients with Rutherford class 2-6. Peri-procedural deoxyhemoglobin changes at the calves and feet are significantly different between limbs with and without clinical improvement. Decrease in deoxyhemoglobin directly after EVT may identify limbs that show clinical improvement 6 weeks after EVT.
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Affiliation(s)
- Simone F Kleiss
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Kirsten F Ma
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Mostafa El Moumni
- Department of Surgery, Division of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Çagdas Ünlü
- Department of Vascular Surgery, Noordwest Hospital Group, Alkmaar, The Netherlands
| | - Thomas S Nijboer
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Richte C L Schuurmann
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Reinoud P H Bokkers
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jean-Paul P M de Vries
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Ramirez-GarciaLuna JL, Bartlett R, Arriaga-Caballero JE, Fraser RDJ, Saiko G. Infrared Thermography in Wound Care, Surgery, and Sports Medicine: A Review. Front Physiol 2022; 13:838528. [PMID: 35309080 PMCID: PMC8928271 DOI: 10.3389/fphys.2022.838528] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/26/2022] [Indexed: 12/25/2022] Open
Abstract
For many years, the role of thermometry was limited to systemic (core body temperature) measurements (e.g., pulmonary catheter) or its approximation using skin/mucosa (e.g., axillary, oral, or rectal) temperature measurements. With recent advances in material science and technology, thermal measurements went beyond core body temperature measurements and found their way in many medical specialties. The article consists of two primary parts. In the first part we overviewed current clinical thermal measurement technologies across two dimensions: (a) direct vs. indirect and (b) single-point vs. multiple-point temperature measurements. In the second part, we focus primarily on clinical applications in wound care, surgery, and sports medicine. The primary focus here is the thermographic imaging modality. However, other thermal modalities are included where relevant for these clinical applications. The literature review identified two primary use scenarios for thermographic imaging: inflammation-based and perfusion-based. These scenarios rely on local (topical) temperature measurements, which are different from systemic (core body temperature) measurements. Quantifying these types of diseases benefits from thermographic imaging of an area in contrast to single-point measurements. The wide adoption of the technology would be accelerated by larger studies supporting the clinical utility of thermography.
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Affiliation(s)
- Jose L. Ramirez-GarciaLuna
- Swift Medical Inc., Toronto, ON, Canada
- Division of Experimental Surgery, McGill University, Montreal, QC, Canada
| | | | | | - Robert D. J. Fraser
- Swift Medical Inc., Toronto, ON, Canada
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Gennadi Saiko
- Swift Medical Inc., Toronto, ON, Canada
- Department of Physics, Ryerson University, Toronto, ON, Canada
- *Correspondence: Gennadi Saiko,
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Wermelink B, Ma KF, Haalboom M, El Moumni M, de Vries JPPM, Geelkerken RH. A Systematic Review and Critical Appraisal of Peri-Procedural Tissue Perfusion Techniques and their Clinical Value in Patients with Peripheral Arterial Disease. Eur J Vasc Endovasc Surg 2021; 62:896-908. [PMID: 34674935 DOI: 10.1016/j.ejvs.2021.08.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/19/2021] [Accepted: 08/13/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Many techniques have been introduced to enable quantification of tissue perfusion in patients with peripheral arterial disease (PAD). Currently, none of these techniques is widely used to analyse real time tissue perfusion changes during endovascular or surgical revascularisation procedures. The aim of this systematic review was to provide an up to date overview of the peri-procedural applicability of currently available techniques, diagnostic accuracy of assessing tissue perfusion and the relationship with clinical outcomes. DATA SOURCES MEDLINE, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials. REVIEW METHODS This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) guidelines. Four electronic databases were searched up to 31 12 2020 for eligible articles: MEDLINE, Embase, CINAHL and the Cochrane Central Register of Controlled Trials. Eligible articles describing a perfusion measurement technique, used in a peri-procedural setting before and within 24 hours after the revascularisation procedure, with the aim of determining the effect of intervention in patients with PAD, were assessed for inclusion. The QUADAS-2 tool was used to assess the risk of bias and applicability of the studies. RESULTS An overview of 10 techniques found in 26 eligible articles focused on study protocols, research goals, and clinical outcomes is provided. Non-invasive techniques included laser speckle contrast imaging, micro-lightguide spectrophotometry, magnetic resonance imaging perfusion, near infrared spectroscopy, skin perfusion pressure, and plantar thermography. Invasive techniques included two dimensional perfusion angiography, contrast enhanced ultrasound, computed tomography perfusion imaging, and indocyanine green angiography. The results of the 26 eligible studies, which were mostly of poor quality according to QUADAS-2, were without exception, not sufficient to substantiate implementation in daily clinical practice. CONCLUSION This systematic review provides an overview of 10 tissue perfusion assessment techniques for patients with PAD. It seems too early to appoint one of them as a reference standard. The scope of future research in this domain should therefore focus on clinical accuracy, reliability, and validation of the techniques.
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Affiliation(s)
- Bryan Wermelink
- University of Twente, Multi-Modality Medical Imaging Group, TechMed Centre, Enschede, The Netherlands; Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, The Netherlands.
| | - Kirsten F Ma
- Department of Surgery, Division of Vascular Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Marieke Haalboom
- Medical School Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Mostafa El Moumni
- Department of Surgery, Division of Trauma Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Jean-Paul P M de Vries
- Department of Surgery, Division of Vascular Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Robert H Geelkerken
- University of Twente, Multi-Modality Medical Imaging Group, TechMed Centre, Enschede, The Netherlands; Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
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