Noninvasive Techniques for the Determination of Burn Severity in Real Time

Abstract

Visual diagnosis of second-degree burns has proven inadequate for determining the appropriate treatment regimen. Although multiple noninvasive imaging techniques have shown promise for providing information about burn wound severity, the ideal technology to aid burn wound excision would provide real-time readouts. Herein, the authors examine a high-resolution infrared (IR) camera (thermography) and a multiprobe adapter system (MPAS-6; transepidermal evaporative water loss, colorimetry) to assess their usefulness in predicting burn severity. Contact burn wounds of increasing severity were created in a porcine model. Wounds were assessed for 4 days with an IR camera and MPAS-6. In addition, each day, the burn wounds were biopsied for histological analysis to determine burn depth for correlation with noninvasive measures. Surface temperatures decreased with increasing burn severity, which was associated with increasing transepidermal evaporative water loss. Melanin content correlated with the depth of collagen coagulation and was bimodal, with superficial and full-thickness burns having higher values than deep partial thickness wounds. Erythema content was highest in superficial burns and negatively correlated with necrosis (high-mobility group box protein 1 expression). Importantly, surface temperature taken on every single day after injury was predictive of all histologically determined measurements of burn depth (ie, collagen coagulation, apoptosis, necrosis, vascular occlusion). The results indicate that IR imaging and skin quality probes can be used to support the diagnosis of burn severity. Most importantly, IR measurements gave insight into both the zone of coagulation and the zone of stasis on every postburn day studied.

Evaluating clinical observation versus Spatial Frequency Domain Imaging (SFDI), Laser Speckle Imaging (LSI) and thermal imaging for the assessment of burn depth

“…burns.2018.09.026 time feedback to clinicians. Hand-held systems have recently been commercialized and these are relatively inexpensive [9]. However thermal imaging can be very sensitive to fluctuations in ambient temperature [10] and studies that have directly compared laser Doppler techniques and thermal imaging have found that laser Doppler can be more accurate in terms of categorizing burn severity [8].…”

“…In relation to burn wound severity, it is typically used to identify regions of tissue within a burn that demonstrate reduced surface temperature relative to some baseline normal skin surface temperature. The reduction in temperature suggests that in these areas, the underlying blood vessels have been damaged to the point where the lack of perfusion leads to a reduction in thermal emission and this can be empirically related to burn depth [8][9][10]. Recent studies suggest that thermography is only as accurate as photographic clinical assessments, and is highly dependent on the ambient temperature during measurements [4].…”

Delivery of Allogeneic Adipose Stem Cells in Polyethylene Glycol-Fibrin Hydrogels as an Adjunct to Meshed Autografts After Sharp Debridement of Deep Partial Thickness Burns

“…Three‐centimeter brass probes were heated to 100°C and handled with a spring‐loaded insulated device for consistent pressure , which measured 0.9 ± 0.05 kg/cm 2 . Heated probes were applied to the skin within tattoo markings for 25 seconds, which has previously been shown to produce deep partial thickness burns via both histological and noninvasive methods . Twelve wounds were created on each animal, with six on either side of the spine.…”

A Critical Update of the Assessment and Acute Management of Patients with Severe Burns

“…102 Photoacoustic imaging was shown to be superior to LDI in detecting burn depth in animals, 103 although a systematic review recently concluded that LDI is superior to other imaging modalities. 104 Other imaging modalities to assess burn depth include near-infrared spectroscopy, 105 ultrasound, 106 skin quality probes, 107 nuclear magnetic resonance imaging 108 capillary microscopy, orthogonal polarization spectral imaging, reflectance mode confocal microscopy, and polarization-sensitive optical coherence. 109 These modalities require further testing before they are used routinely in the clinical setting.…”