Non‐invasive objective devices for monitoring the inflammatory, proliferative and remodelling phases of cutaneous wound healing and skin scarring

Abstract

Objective evaluation of cutaneous wounds through the use of non-invasive devices is important for diagnosis, monitoring treatment response and can lead to the development of improved theranostic strategies. The need for objective monitoring of wound healing and scar formation is evident as this enables accurate diagnosis, evaluation and prognosis for clinicians and allows for the standardisation and validation of methodology for researchers. Therefore, this review provides an overview of the current application of non-invasive objective technologies for the assessment of wound healing through the different phases of repair. We propose that cutaneous healing parameters can be split into three core domains: anatomical, mechanical and physiological. These categories can be further subdivided with respect to specific phases of healing. There is no single instrument, which can measure all the parameters of healing simultaneously; thus, it is important to choose the correct device for the particular healing characteristics being monitored. However, multiprobe systems, which include a number of devices connected to one main unit, are useful as they enable multiple measurements of different parameters. Many of the devices have not been validated against histological examination. Additionally, some of the instruments have not been evaluated in all wound or scar types and may not be useful throughout all phases of cutaneous wound healing. In conclusion, non-invasive objective devices are useful in the assessment of cutaneous wound healing, as these tools can link the treatment and diagnosis by evaluating response to treatment and thus could aid as a marker for healing and scar maturation.

Probing endogenous collagen by laser‐induced autofluorescence in burn wound biopsies: A pilot study

“…In clinical wound management, periodic evaluation of injured tissue is of tremendous importance to assess the severity and to comprehend the outcome of the treatment modality thus saving time and resources . Conventional wound assessment is mainly dependent on intermittent visual examination by the trained clinician, this often considered as “subjective” fails to provide in‐depth information on the wound bed . Currently, suitable gold standard tools for assessing wound healing are histopathology and biochemical analysis of hydroxyproline, wherein both the techniques measure the amount of collagen deposited, invasively.…”

“…Currently, suitable gold standard tools for assessing wound healing are histopathology and biochemical analysis of hydroxyproline, wherein both the techniques measure the amount of collagen deposited, invasively. Thus, there is a growing need for the discovery of methodologies for objective assessment of wound healing which will provide the minute and complete evidence regarding various components of the skin indiscernible to routine visual examination . Also, selection of an appropriate objective and noninvasive assessment methodology is essential for the development of novel theranostic strategies in wound management to reduce mental stress and mortality associated with burn injury .…”

“…Thus, there is a growing need for the discovery of methodologies for objective assessment of wound healing which will provide the minute and complete evidence regarding various components of the skin indiscernible to routine visual examination . Also, selection of an appropriate objective and noninvasive assessment methodology is essential for the development of novel theranostic strategies in wound management to reduce mental stress and mortality associated with burn injury . As a consequence of continual research in the field of wound management, some optical technologies have been developed in recent past for quick, noninvasive and objective assessment of wounds .…”

“…Also, selection of an appropriate objective and noninvasive assessment methodology is essential for the development of novel theranostic strategies in wound management to reduce mental stress and mortality associated with burn injury . As a consequence of continual research in the field of wound management, some optical technologies have been developed in recent past for quick, noninvasive and objective assessment of wounds . These include near‐infrared imaging, thermal imaging, optical coherence tomography, orthogonal polarization spectral imaging, fluorescence imaging, laser Doppler imaging, microscopy, spatial frequency domain imaging, photoacoustic detection, second harmonic generation microscopy, polarization imaging, small angle X‐ray imaging and magnetic resonance imaging .…”

“…These include near‐infrared imaging, thermal imaging, optical coherence tomography, orthogonal polarization spectral imaging, fluorescence imaging, laser Doppler imaging, microscopy, spatial frequency domain imaging, photoacoustic detection, second harmonic generation microscopy, polarization imaging, small angle X‐ray imaging and magnetic resonance imaging . Even though, aforementioned assessment technologies provide quantitative information on both anatomical and physiological characteristics, such as skin thickness, blood flow, collagen remodeling, inflammation and vascular structure; however, up to now no single valid and reliable technique be available to measure all the parameters of healing at once . Moreover, most of the techniques have its limitations; this may not be utilized throughout all the phases of tissue repair.…”