Burn wound healing time assessed by laser Doppler imaging. Part 2: Validation of a dedicated colour code for image interpretation

Burns are one of the most devastating conditions encountered in medicine. This injury is in skin or other tissues, caused by heat-cold, electricity or chemicals [1,2]. There are lots of methods to treat burns and each method has its own advantages, such as medicine, dressing, low-level laser, plasma, skin graft surgery... [3].This study experimented with the 3rd degree burn model in mice by heat, treating by DBD plasma, is a non-invasive treatment and using clinical diagnostic methods by (1) normal image, (2) thermal image, (3) HE staining. Aim of this research is evaluation and comparison the area, temperature and wound healing time of non-invasive treatment with DBD plasma and nontreatment. After 3-week experiment, using diagnostic methods and analysis tools have demonstrated that the 3rd thermal burn wound healing of plasma treatment recovers faster than non-treatment about: (1) Burn wound surface shrinkage rate is higher: ~ 5%; (2) Healing time is faster: 2-3 days; (3) The average temperature of the burn wound is lower: 1-2oC. Therefore, DBD plasma is a potential treatment in burns wound and wound healing in the future. Keywords: DBD plasma, burn wound, healing wound

Download Full-text

A prospective study comparing the FLIR ONE with laser Doppler imaging in the assessment of burn depth by a tertiary burns unit in the United Kingdom

Scars Burns & Healing ◽

10.1177/2059513120974261 ◽

2020 ◽

Vol 6 ◽

pp. 205951312097426

Author(s):

Jay Goel ◽

Metin Nizamoglu ◽

Alethea Tan ◽

Helen Gerrish ◽

Karen Cranmer ◽

...

Keyword(s):

Blood Flow ◽

Burn Injury ◽

Normal Skin ◽

Healing Time ◽

Laser Doppler ◽

Doppler Imaging ◽

Laser Doppler Imaging ◽

Burn Wound ◽

Temperature Changes ◽

Burn Depth

Introduction: Laser Doppler imaging (LDI) is the ‘gold standard’ tool for the assessment of burn depth. However, it is costly. The FLIR ONE is a novel, mobile-attached, thermal imaging camera used to assess burn wound temperature. This study compares the FLIR ONE and LDI in assessing burn depth and predicting healing times. Methods: Forty-five adult patients with burn wounds, presenting at 1–5 days, were imaged with the FLIR ONE and LDI. Infected, chemical and electrical burns were excluded. Healing potential was determined by comparing wound and normal skin temperature for the FLIR ONE and blood flow changes with the LDI. Healing potential was categorised into wounds healing in less than and over 21 days. Pearson’s test was used to determine the correlation between changes in wound temperature and healing potential. Results: Percent total body surface area (%TBSA) was in the range of 0.5–45. FLIR demonstrated a sensitivity of 66.67% and specificity of 76.67% in predicting healing within 21 days, while LDI demonstrated a sensitivity of 93.33% and specificity of 40%. The FLIR ONE showed a significant difference in the mean temperature changes between burns that healed in less than (0.1933 ± 0.3554) and over 21 days (–1 ± 0.4329) ( P = 0.04904). Pearson’s test showed a significant correlation between the difference in wound and normal skin temperature with healing times ( P = 0.04517). Conclusion: The inexpensive FLIR ONE shows a significant correlation between changes in wound temperature and healing times. It is useful in predicting healing within 21 days. However, evaporative cooling at the wound surface can lead to overprediction of healing times and overtreatment. Lay Summary Background Laser Doppler imaging is currently the main tool for burn depth assessment. It works by analysing the blood flow in a burn wound. Based on these findings, it can predict the depth of the burn injury and predict if it will heal in less than or over 21 days. The main problem is that it is costly. The FLIR ONE is a novel, mobile-attached, thermal imaging camera. It can be used to assess burn depth by comparing the temperature of the burn wound to the surrounding normal skin. This information can then be used to predict healing times into less than and over 21 days. The issue being explored The usefulness of the FLIR ONE in assessing burn depth and predicting healing time when compared to the LDI. How was the work conducted? Forty-five adult patients who sustained a burn injury within the last five days were imaged with both the FLIR ONE and LDI. Those with infected, electrical or chemical burns were excluded. Healing potential was determined by comparing the temperature of the burn wound with normal skin for the FLIR ONE and by changes in wound blood flow with the LDI. Healing potential was categorised into wounds healing in less than and over 21 days. The correlation between the temperature changes of the burn wound and healing time was evaluated for the FLIR ONE. What we learned from the study This study was able to demonstrate that the FLIR ONE showed a significant correlation between the temperature difference between the burn wound and normal skin with healing times. When compared with the LDI, the FLIR ONE was useful in predicting if a burn wound will heal in less than 21 days. The FLIR ONE has advantages over the LDI, it is low cost, portable and produces instantaneous images. Ultimately, this developing technology may increase access to higher standard burn care in centres where LDI is not affordable.

Download Full-text

734 A Comparison of Burn Depth Assessment Between Clinical Diagnosis and Laser Doppler Imaging

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.317 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S199-S199

Author(s):

Suzanne Mitchell ◽

Dhaval Bhavsar ◽

Jessica Reynolds ◽

Jessica Jones ◽

Julia M Pena

Keyword(s):

Wound Healing ◽

Clinical Diagnosis ◽

Laser Doppler ◽

Burn Injuries ◽

Burn Wound ◽

Burn Wound Healing ◽

Partial Thickness ◽

Partial Thickness Burn ◽

Doppler Image ◽

Burn Depth

Abstract Introduction Accurate burn assessment is crucial to prescribing appropriate treatment and is dependent upon the experience of the provider and the timing of diagnosis relative to the burn injury evaluation. Differentiating between a deep partial thickness and full thickness burn may not be easily discernible. To augment the clinical diagnosis of burn depth, a laser doppler image measures the microvascular blood flow of injured tissue to predict burn wound healing. The aim of this study is to evaluate the clinical assessment of burn wounds by experienced burn providers compared to the laser doppler image assessment in predicting which burn wounds should heal spontaneously in 3 weeks. Methods A retrospective chart review from 2012–2016, included 54 subjects. The clinical assessment included a description of burn variables relevant to the determination of spontaneous burn wound healing (burn depth, total body surface area, mechanism of injury, anatomical location, clinical burn depth diagnosis, and laser doppler image). A chi-square analysis compared the clinical diagnosis and the laser doppler assessment of burn wound depth, as well as the correlation between clinical diagnosis versus laser doppler image in predicting spontaneous burn wound healing. Results Comparing partial thickness burn injuries, there were 38 clinically diagnosed partial thickness injuries (by experienced burn providers) and 38 partial thickness burn injures diagnosed via LDI. Deep partial thickness burn injuries were diagnosed clinically in 9 subjects, compared to 10 via LDI. Full thickness burn injuries were diagnosed clinically in 7 subjects and 6 via LDI. A chi-square test was performed to examine the relationship between clinical diagnosis of burn depth and laser doppler image. The relation between these variables was significant,X2= 26.884, p< .000. Comparing clinically diagnosed burn depth to LDI, each approach (clinical or LDI) diagnosed 42 subjects with partial thickness or deep partial thickness burn injuries and all healed spontaneously. Two of the clinically diagnosed full thickness burn injuries required skin grafting. Six patients were lost to follow-up (X2= 17.745, p < .001). Conclusions This study confirms there is no difference between an experienced burn provider’s clinical diagnosis of burn wound depth and prognosis for spontaneous healing compared to a laser doppler image prognosis of burn wound healing. Applicability of Research to Practice In an era of advanced technologies, expert clinical bedside assessment is the standard of care.

Download Full-text

The Use of Stem Cells in Burn Wound Healing: A Review

BioMed Research International ◽

10.1155/2015/684084 ◽

2015 ◽

Vol 2015 ◽

pp. 1-9 ◽

Cited By ~ 42

Author(s):

Fadi Ghieh ◽

Rosalyn Jurjus ◽

Amir Ibrahim ◽

Alice Gerges Geagea ◽

Hisham Daouk ◽

...

Keyword(s):

Stem Cells ◽

Wound Healing ◽

Therapeutic Effect ◽

Healing Time ◽

Burn Injuries ◽

Burn Wound ◽

Burn Wounds ◽

Complex Processes ◽

Burn Wound Healing

Burn wound healing involves a series of complex processes which are subject to intensive investigations to improve the outcomes, in particular, the healing time and the quality of the scar. Burn injuries, especially severe ones, are proving to have devastating effects on the affected patients. Stem cells have been recently applied in the field to promote superior healing of the wounds. Not only have stem cells been shown to promote better and faster healing of the burn wounds, but also they have decreased the inflammation levels with less scar progression and fibrosis. This review aims to highlight the beneficial therapeutic effect of stem cells in burn wound healing and to discuss the involved pathways and signaling molecules. The review covers various types of burn wound healing like skin and corneal burns, along with the alternative recent therapies being studied in the field of burn wound healing. The current reflection of the attitudes of people regarding the use of stem cells in burn wound healing is also stated.

Download Full-text

Increased burn healing time is associated with higher Vancouver Scar Scale score

Scars Burns & Healing ◽

10.1177/2059513117696324 ◽

2017 ◽

Vol 3 ◽

pp. 205951311769632 ◽

Cited By ~ 3

Author(s):

Vidya Finlay ◽

Sally Burrows ◽

Maddison Burmaz ◽

Hussna Yawary ◽

Johanna Lee ◽

...

Keyword(s):

Wound Healing ◽

Total Body Surface Area ◽

Likelihood Estimation ◽

Healing Time ◽

Burn Wound ◽

Interaction Terms ◽

Burn Wound Healing ◽

Primary Model ◽

Burn Surgery ◽

The Relationship

[Formula: see text] Increased burn wound healing time has been shown to influence abnormal scarring. This study hypothesised that scar severity increases commensurate to the increase in time to healing (TTH) of the wound. Wound healing and scar data from burn patients treated by the Burn Service of Western Australia at Royal Perth Hospital were examined. The relationship between TTH and scar severity, as assessed by the modified Vancouver Scar Scale (mVSS), was modelled using regression analysis. Interaction terms evaluated the effect of surgery and total body surface area – burn (TBSA) on the main relationship. Maximum likelihood estimation was used to account for potential bias from missing independent variable data. The sample had a median age of 34 years, TTH of 24 days, TBSA of 3% and length of stay of five days, 70% were men and 71% had burn surgery. For each additional day of TTH, the mVSS score increased by 0.11 points ( P ≤ 0.001) per day in the first 21 days and 0.02 points per day thereafter ( P = 0.004). The relationship remained stable in spite of TBSA or surgical intervention. Investigation of the effect of missing data revealed the primary model underestimated the strength of the association. An increase in TTH within 21 days of injury is associated with an increase in mVSS or reduced scar quality. The results confirm that efforts should be directed toward healing burn wounds as early as possible.

Download Full-text