Design of a Skin Grafting Methodology for Burn Wound Using an Additive Biomanufacturing System Guided by Hyperspectral Imaging

2016 ◽  
Author(s):  
Houzhu Ding ◽  
Antonio Dole ◽  
Filippos Tourlomousis ◽  
Robert C. Chang
Keyword(s):  
Hyperspectral Imaging ◽  
Hemoglobin Concentration ◽  
Skin Grafting ◽  
Medical Intervention ◽  
Three Dimensions ◽  
Patient Specific ◽  
Skin Burn ◽  
Burn Wound ◽  
Thermal Burn ◽  
Tissue Scaffold

Skin thermal burn wounds are classified by depth and require different levels of medical intervention. In this paper, the authors propose a novel treatment method where hyperspectral imaging (HSI) is applied to measure skin burn wound information that guide an additive biomanufacturing process to print a custom engineered skin graft in three dimensions (3D). Two dimensional principle component analysis (2DPCA) for noise reduction is applied to images captured by HSI in the visible wavelength range from 375 nm to 750 nm. A multivariate regression analysis is used to calculate hemodynamic biomarkers of skin burns, specifically the total hemoglobin concentration (tHb) and oxygen saturation (StO2) of the injured tissue. The biomarker results of the skin burn images are mapped spatially to show the burn wound depth distribution. Based on the biomarker values, the burn area is segmented into different sub areas with different burn degrees. Depth profiles of deep burns which require skin grafting are extracted from the burn distribution map. Next, each profile is processed to generate an additive biomanufacturing toolpath with a prescribed internal tissue scaffold structure. Using the toolpath, a 3D printer processes a custom graft from an alginate polymer hydrogel material. Alginate is chosen as the print material since it can be stretched into aligned fibers to create a porous structure that facilitates oxygen and nutrient uptake. The resultant printed construct demonstrates the feasibility of fabricating patient-specific tissues with custom-geometry grafts for treating clinical burns.

Hyperspectral Imaging With Burn Contour Extraction for Burn Wound Depth Assessment

2018 ◽  
Vol 1 (4) ◽  
Author(s):  
Houzhu Ding ◽  
Robert C. Chang
Keyword(s):  
Hyperspectral Imaging ◽  
Assessment Tool ◽  
Color Image ◽  
Early Stage ◽  
Principal Component ◽  
Medical Intervention ◽  
Burn Wound ◽  
Thermal Burn ◽  
Partial Thickness ◽  
Partial Thickness Burns

Skin thermal burn wounds are classified according to subjective assessments of wound depth that indicate divergent modes of medical intervention. However, clinically discriminating superficial partial from deep partial thickness burns remains a significant challenge, where only the latter requires excision and skin grafting. Motivated by the need for and ramifications of an objective burn wound assessment tool, this paper advances hyperspectral imaging (HSI) in a porcine skin burn model to quantitatively evaluate thermal burn injuries (superficial and deep partial thickness burns). Two-dimensional (2D) principal component analysis for noise reduction is applied to images captured by HSI in the visible wavelength range. Herein, a multivariate regression analysis is used to calculate the total hemoglobin concentration (tHb) and the oxygen saturation (StO2) of the injured tissue. These perfusion profiles are spatially mapped to yield characteristic distributions corresponding to the burn wound degree validated histologically. The results demonstrate that StO2 and tHb diverge significantly for superficial partial and deep partial burns at 24 h and 1 h, respectively (p < 0.05). A StO2 burn map at 1 h post-burn yields a 2D burn contour that is registered with a burn color image. This early stage burn-specific contour has implications to guide downstream burn excision and grafting.

scholarly journals Calcium Homeostasis Comparison in Thermal Burn Patients–Early Tangential Excision and Grafting versus Conservative Management

2020 ◽  
Vol 53 (03) ◽  
pp. 381-386
Author(s):  
Sonika Jha ◽  
Parul Goyal ◽  
Sameek Bhattacharya ◽  
Shilpi Baranwal
Keyword(s):  
Calcium Homeostasis ◽  
Conservative Management ◽  
Bone Mineralization ◽  
Skin Grafting ◽  
Urinary Calcium ◽  
Wound Management ◽  
Categorical Variables ◽  
P Value ◽  
Burn Wound ◽  
Thermal Burn

Abstract Introduction With the advent of better burn wound management protocols, early excision and grafting, increased number of burns patients are surviving and entering the struggle of prolonged rehabilitation. Calcium homeostasis and its influence on bone mineralization plays an important role, but it is adversely influenced by the proinflammatory state in burns, leading to hypocalcemia and paradoxical hypercalciuria which, in turn, leads to excessive bony resorption and pathological fractures. The role of early excision in the overall metabolism of calcium is being investigated in the study. Method This study was undertaken in a tertiary level government-run hospital from February 2018 to August 2019. A total of 28 patients with second degree thermal burns were included. For all patients, fasting serum parathormone levels along with various serum electrolytes like Ca2+,Mg2+, PO4 3- and urinary calcium levels were serially measured from day of admission to 2 months. The first group of 14 patients (Group A) underwent early tangential excision and skin grafting, whereas another 14 patients (Group B) underwent conservative management. All categorical variables were analyzed with the help of Chi square test. A p value of < 0.05 was considered statistically significant. Result There was a statistically significant improvement in serum parathormone and other electrolytes’ levels in the tangential excision group. Similarly, urinary excretion of calcium also showed favorable results in the group. Conclusion Early tangential excision and grafting in burns plays an important role in maintaining serum parathormone and calcium levels, leading to prevention of hypercalciuria and optimization of other factors affecting calcium homeostasis.

scholarly journals A Narrative Review of the History of Skin Grafting in Burn Care

Medicina ◽  
2021 ◽  
Vol 57 (4) ◽  
pp. 380
Author(s):  
Deepak K. Ozhathil ◽  
Michael W. Tay ◽  
Steven E. Wolf ◽  
Ludwik K. Branski
Keyword(s):  
Donor Site ◽  
Subsequent Development ◽  
Skin Grafting ◽  
Human Condition ◽  
Surgical Instruments ◽  
Wound Management ◽  
Burn Wound ◽  
Medical Progress ◽  
Burn Care ◽  
History Of

Thermal injuries have been a phenomenon intertwined with the human condition since the dawn of our species. Autologous skin translocation, also known as skin grafting, has played an important role in burn wound management and has a rich history of its own. In fact, some of the oldest known medical texts describe ancient methods of skin translocation. In this article, we examine how skin grafting has evolved from its origins of necessity in the ancient world to the well-calibrated tool utilized in modern medicine. The popularity of skin grafting has ebbed and flowed multiple times throughout history, often suppressed for cultural, religious, pseudo-scientific, or anecdotal reasons. It was not until the 1800s, that skin grafting was widely accepted as a safe and effective treatment for wound management, and shortly thereafter for burn injuries. In the nineteenth and twentieth centuries skin grafting advanced considerably, accelerated by exponential medical progress and the occurrence of man-made disasters and global warfare. The introduction of surgical instruments specifically designed for skin grafting gave surgeons more control over the depth and consistency of harvested tissues, vastly improving outcomes. The invention of powered surgical instruments, such as the electric dermatome, reduced technical barriers for many surgeons, allowing the practice of skin grafting to be extended ubiquitously from a small group of technically gifted reconstructive surgeons to nearly all interested sub-specialists. The subsequent development of biologic and synthetic skin substitutes have been spurred onward by the clinical challenges unique to burn care: recurrent graft failure, microbial wound colonization, and limited donor site availability. These improvements have laid the framework for more advanced forms of tissue engineering including micrografts, cultured skin grafts, aerosolized skin cell application, and stem-cell impregnated dermal matrices. In this article, we will explore the convoluted journey that modern skin grafting has taken and potential future directions the procedure may yet go.

The Use of Visible-Light Hyperspectral Imaging in Evaluating Burn Wounds: A Case Report

2021 ◽  
Author(s):  
Melissa McCarthy ◽  
Victoria Irene Prete ◽  
SeungJu Oh ◽  
Garrick Gu ◽  
Jorge Lujan-Hernandez ◽  
...  
Keyword(s):  
Case Report ◽  
Visible Light ◽  
Hyperspectral Imaging ◽  
Initial Evaluation ◽  
Contrast Imaging ◽  
Post Injury ◽  
Irreversible Damage ◽  
Thermal Burn ◽  
Burn Depth ◽  
Second Degree

Abstract Burn depth is a critical factor in determining the healing potential of a burn as the extent of injury ultimately guides overall treatment. Visible Light Hyperspectral Imaging is an FDA-approved, non-invasive, and non-contrast imaging technology that uses light waves within the visible spectrum to evaluate skin and superficial soft tissue perfusion. In this case report, Visible Light Hyperspectral Imaging was used to evaluate a 37-year-old male who presented to the Emergency Department with a thermal burn of the trunk, back, and right upper extremity. Images were taken at initial evaluation, 6-hours post-injury, and again during daily dressing changes until hospital day five when patient underwent surgical debridement. In this patient, operative treatment was postponed until 89.7-hours post-injury, at which point the clinical exam showed clear visual demarcation in regions of irreversible damage. Comparatively, Visible Light Hyperspectral Imaging analysis of the permanently injured tissue demonstrated acute but varying changes in both oxygenated hemoglobin and deoxygenated hemoglobin at the time of initial evaluation. The most dramatic change in tissue oxygenation occurred between 6.5 and 39.3 hours, demonstrating Visible Light Hyperspectral Imaging’s ability to detect significant differences in oxygenation values between areas of second-degree superficial burns and areas of second degree deep and third degree burns in the acute period. The data suggest that the utilization of Visible Light Hyperspectral Imaging in this 6.5-39.3-hour window may help predict final burn depth before clinical assessment, potentially allowing for surgical intervention within the first 48-hours following injury.

scholarly journals Burns Management In Tertiary Health Care Centre

2021 ◽  
Vol 12 (1) ◽  
pp. 544-550
Author(s):  
Ajitsingh .P. Chadha ◽  
Nehadeepkaur A Chadha ◽  
Kshirsagar A Y
Keyword(s):  
Health Care ◽  
Skin Grafting ◽  
Cost Effective ◽  
Surgical Excision ◽  
Burn Wound ◽  
Health Care Centre ◽  
Burn Scar ◽  
Wound Excision ◽  
Contracture Formation ◽  
Rural Places

In rural places of our country, burns have become frequent accidents due to the use of floor-based stoves & kerosene lamps. Suicides due to burns are also quite usual in our country. The objective of this study is to evaluate the necessity of early excision of the burn wound and skin grafting to decrease the morbidity, mortality, complications of burns and stay at the hospital. Calculate pressure garment efficacy in preventing burn scar and contracture formation. To lay out cost-effective management for patients at rural hospitals. 50 patients were included in this study presenting with burn injuries, admitted in the department of plastic surgery from June 2019 to December 2020. In a recent study, Females (52%) suffered more as compared to males. Scalds were the prime root cause of the burns constituting the 52% of the cases. Infections of Burn wound was seen in 20 patients (40%). Pseudomonas was prime organism isolated. Wound excision was required in 19 patients (38%). Around 6 to 12 days, elapsed between the injury to the surgical excision. 19 patients required (38%) covering of wound permanently with STSG. The mean admission period in hospital for burns of 41-60% was 62 days, 33.4 days for 21-40% burns and 19.6 days for <20%. Amongst 50 patients, 3 died accounting to 6% of overall cases. This study concluded that initiation of resuscitation with untimely wound excision and permanent coverage with grafting can bring significant fall in mortality, painful debridements, limiting complications, decreasing the duration of stay at a hospital, curtailing the cost of health care and time apart from work.

scholarly journals A 3D In Vitro Model for Burn Wounds: Monitoring of Regeneration on the Epidermal Level

Biomedicines ◽  
2021 ◽  
Vol 9 (9) ◽  
pp. 1153
Author(s):  
Verena Schneider ◽  
Daniel Kruse ◽  
Ives Bernardelli de Mattos ◽  
Saskia Zöphel ◽  
Kendra-Kathrin Tiltmann ◽  
...  
Keyword(s):  
Wound Healing ◽  
Inflammatory Response ◽  
Healing Process ◽  
Three Dimensional ◽  
Source Model ◽  
Burn Wound ◽  
Thermal Burn ◽  
Burn Wounds

Burns affect millions every year and a model to mimic the pathophysiology of such injuries in detail is required to better understand regeneration. The current gold standard for studying burn wounds are animal models, which are under criticism due to ethical considerations and a limited predictiveness. Here, we present a three-dimensional burn model, based on an open-source model, to monitor wound healing on the epidermal level. Skin equivalents were burned, using a preheated metal cylinder. The healing process was monitored regarding histomorphology, metabolic changes, inflammatory response and reepithelialization for 14 days. During this time, the wound size decreased from 25% to 5% of the model area and the inflammatory response (IL-1β, IL-6 and IL-8) showed a comparable course to wounding and healing in vivo. Additionally, the topical application of 5% dexpanthenol enhanced tissue morphology and the number of proliferative keratinocytes in the newly formed epidermis, but did not influence the overall reepithelialization rate. In summary, the model showed a comparable healing process to in vivo, and thus, offers the opportunity to better understand the physiology of thermal burn wound healing on the keratinocyte level.

Dermal Nanoemulsion Treatment Reduces Burn Wound Conversion and Improves Skin Healing in a Porcine Model of Thermal Burn Injury

2021 ◽  
Author(s):  
Vladislav A Dolgachev ◽  
Susan Ciotti ◽  
Emma Liechty ◽  
Benjamin Levi ◽  
Stewart C Wang ◽  
...  
Keyword(s):  
Burn Injury ◽  
Hair Follicles ◽  
Silver Sulfadiazine ◽  
Histological Evaluation ◽  
Full Thickness ◽  
Burn Wound ◽  
Thermal Burn ◽  
Burn Wounds ◽  
Partial Thickness ◽  
Mediators Of Inflammation

Abstract Objective Burn wound progression is an inflammation driven process where an initial partial-thickness thermal burn wound can evolve over time to a full-thickness injury. We have developed an oil-in-water nanoemulsion formulation (NB-201) containing benzalkonium chloride for use in burn wounds that is antimicrobial and potentially inhibits burn wound progression. We used a porcine burn injury model to evaluate the effect of topical nanoemulsion treatment on burn wound conversion and healing. Methods Anesthetized swine received thermal burn wounds using a 25cm 2 surface area copper bar heated to 80 oC. Three different concentrations of NB-201 (10%, 20%, or 40% nanoemulsion), silver sulfadiazine cream or saline were applied to burned skin immediately after injury and on days 1, 2, 4, 7, 10, 14, and 18 post-injury. Digital images and skin biopsies were taken at each dressing change. Skin biopsy samples were stained for histological evaluation and graded. Skin tissue samples were also assayed for mediators of inflammation. Results Dermal treatment with NB-201 diminished thermal burn wound conversion to a full-thickness injury as determined by both histological and visual evaluation. Comparison of epithelial restoration on day 21 showed that 77.8% of the nanoemulsion treated wounds had an epidermal injury score of 0 compared to 16.7% of the silver sulfadiazine treated burns (p=0.01). Silver sulfadiazine cream and saline treated wounds (controls) converted to full-thickness burns by day 4. Histological evaluation revealed reduced inflammation and evidence of skin injury in NB-201 treated sites compared to control wounds. The nanoemulsion treated wounds often healed with complete regrowth of epithelium and no loss of hair follicles (NB-201: 4.8±2.1, saline: 0±0, silver sulfadiazine: 0±0 hair follicles per 4mm biopsy section, p&lt;0.05). Production of inflammatory mediators and sequestration of neutrophils were also inhibited by NB-201. Conclusions Topically applied NB-201 prevented the progression of a partial-thickness burn wound to full-thickness injury and was associated with a concurrent decrease in dermal inflammation.

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