An audit of the use of laser-Doppler Imaging (LDI) in the assessment of burns of intermediate depth
Royal Victoria Infirmary, NE1 4LP, Newcastle upon Tyne, UK. Burns
(Impact Factor: 1.88).
06/2001; 27(3):233-9. DOI: 10.1016/S0305-4179(00)00118-2
This is the first report of an evaluation of the use of a laser Doppler imager (LDI) scanner in the assessment of burn depth in patients. It is based on a 6-month, prospective audit of 76 burns of intermediate depth. Clinical and LDI assessments of burn wound depth were recorded at 48-72 h post-injury. Histological confirmation of depth was obtained from those burns requiring surgery. A healing time of less than 21 days was taken as confirmation of the injury being an superficial dermal burn. The accuracy of LDI in the assessment of burn depth was 97%, compared with 60-80% for established clinical methods. This audit confirms that LDI is a very accurate measurement tool for the assessment of burn wound depth. We recommend that all burns of intermediate depth should be analysed in this way in order to ensure appropriate management of the burn, to avoid unnecessary surgery and to reduce hospital stay and costs.
Available from: Rikke Holmgaard
- "Formålet er at optimere patientforløbet. Skanningen gør det muligt at skelne de operationskraevende fra de ikkeoperationskraevende brandskader . Så hvor man førhen afventede spontan heling af de overfladiske skader, og derefter opererede de dybe skader efter 14 dage, forsøger man nu at ope rere de patienter, der har behov for det, så tidligt i forlø bet som muligt mhp. at forkorte deres indlaeggelsestid. "
[Show abstract] [Hide abstract]
ABSTRACT: This paper aims to clarify the newly revised guidelines regarding burn injuries as to assist medical personnel dealing with burns. The Department of Burns at Rigshospitalet is the main burn centre in Denmark, and thus creates the National Guidelines of burns treatment. The new guidelines have targeted a simplification of the procedures to avoid complications of which especially severe hypothermia as well as an overload in fluid administration are included.
- "Such a tool could also enhance pre-operative planning by providing the clinician with a wound map of burn depth gradients, estimated excision depths, and donor skin area approximations. The most salient potential solutions to improve burn depth estimation include fluorescent dyes, high frequency ultrasound , nuclear imaging (MRI), photography, thermography, and laser Doppler imaging (LDI) . A side by side comparison of these technologies is presented in Table 1. "
[Show abstract] [Hide abstract]
ABSTRACT: Multispectral imaging (MSI) is an optical technique that measures specific wavelengths of light reflected from wound site tissue to determine the severity of burn wounds. A rapid MSI device to measure burn depth and guide debridement will improve clinical decision making and diagnoses.
We used a porcine burn model to study partial thickness burns of varying severity. We made eight 4×4cm burns on the dorsum of one minipig. Four burns were studied intact, and four burns underwent serial tangential excision. We imaged the burn sites with 400-1000nm wavelengths.
Histology confirmed that we achieved various partial thickness burns. Analysis of spectral images show that MSI detects significant variations in the spectral profiles of healthy tissue, superficial partial thickness burns, and deep partial thickness burns. The absorbance spectra of 515, 542, 629, and 669nm were the most accurate in distinguishing superficial from deep partial thickness burns, while the absorbance spectra of 972nm was the most accurate in guiding the debridement process.
The ability to distinguish between partial thickness burns of varying severity to assess whether a patient requires surgery could be improved with an MSI device in a clinical setting.
Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.
Available from: Manaf Khatib
- "Wounds that were deemed to be hyperperfused were managed conservatively with daily dressings and wounds deemed to be hypoperfused were managed surgically within the first 24 h of presentation. They found that the accuracy of LD assessment was 97% compared to 70% by clinical assessment . It is imperative to mention that in 4 cases, the clinician ignored the judgement of the LD assessment, which judged the wound to heal within 21 days, and the cases were taken to theatre for excision and grafting. "
[Show abstract] [Hide abstract]
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.
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.