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.

Background The purpose of this study is to investigate the capabilities of a novel optical wide-field imaging technology known as Spatial Frequency Domain Imaging (SFDI) to quantitatively assess reconstructive tissue status. Methods Twenty two cutaneous pedicle flaps were created on eleven rats based on the inferior epigastric vessels. After baseline measurement, all flaps underwent vascular ischemia, induced by clamping the supporting vessels for two hours (either arterio-venous or selective venous occlusions) normal saline was injected to the control flap, and hypertonic hyperoncotic saline solution to the experimental flap. Flaps were monitored for two hours after reperfusion. The SFDI system was used for quantitative assessment of flap status over the duration of the experiment. Results All flaps demonstrated a significant decline in oxy-hemoglobin and tissue oxygen saturation in response to occlusion. Total hemoglobin and deoxy-hemoglobin were markedly increased in the selective venous occlusion group. After reperfusion and the solutions were administered, oxy-hemoglobin and tissue oxygen saturation in those flaps that survived gradually returned to the baseline levels. However, flaps for which oxy-hemoglobin and tissue oxygen saturation didn’t show any signs of recovery appeared to be compromised and eventually became necrotic within 24–48 hours in both occlusion groups. Conclusion SFDI technology provides a quantitative, objective method to assess tissue status. This study demonstrates the potential of this optical technology to assess tissue perfusion in a very precise and quantitative way, enabling wide-field visualization of physiological parameters. The results of this study suggest that SFDI may provide a means for prospectively identifying dysfunctional flaps well in advance of failure.