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Cretu A, Grosu-Bularda A, Bordeanu-Diaconescu EM, Hodea FV, Ratoiu VA, Dumitru CS, Andrei MC, Neagu TP, Lascar I, Hariga CS. Strategies for Optimizing Acute Burn Wound Therapy: A Comprehensive Review. MEDICINA (KAUNAS, LITHUANIA) 2025; 61:128. [PMID: 39859110 PMCID: PMC11766551 DOI: 10.3390/medicina61010128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2024] [Revised: 01/04/2025] [Accepted: 01/13/2025] [Indexed: 01/27/2025]
Abstract
Recent advancements in acute burn wound therapy are transforming the management of burn injuries, with a focus on improving healing times, graft integration, and minimizing complications. However, current clinical treatments face significant challenges, including the difficulty of accurately assessing wound depth and tissue viability, which can lead to suboptimal treatment planning. Traditional closure methods often struggle with issues such as delayed wound closure, limited graft survival, inadequate tissue regeneration, and insufficient vascularization. Furthermore, managing infection and minimizing scarring remain persistent obstacles, impacting functional recovery and aesthetic outcomes. Key areas of innovation include advanced imaging techniques that enable more precise assessment of wound depth, size, and tissue viability, allowing for more accurate treatment planning. In addition, new closure strategies are being developed to accelerate wound closure, enhance graft survival, and address challenges such as tissue regeneration, vascularization, and infection prevention. These strategies aim to optimize both functional recovery and aesthetic outcomes, reducing scarring and improving the quality of life for burn patients. While promising, these emerging techniques require further research and clinical validation to refine their effectiveness and expand their accessibility. Together, these innovations represent a significant shift in acute burn care, offering the potential for more personalized, efficient, and effective treatments.
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Affiliation(s)
- Andrei Cretu
- Department 11, Discipline Plastic and Reconstructive Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.C.)
- Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
| | - Andreea Grosu-Bularda
- Department 11, Discipline Plastic and Reconstructive Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.C.)
- Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
| | - Eliza-Maria Bordeanu-Diaconescu
- Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
| | - Florin-Vlad Hodea
- Department 11, Discipline Plastic and Reconstructive Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.C.)
- Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
| | - Vladut-Alin Ratoiu
- Department 11, Discipline Plastic and Reconstructive Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.C.)
- Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
| | - Catalina-Stefania Dumitru
- Department 11, Discipline Plastic and Reconstructive Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.C.)
- Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
| | - Mihaela-Cristina Andrei
- Department 11, Discipline Plastic and Reconstructive Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.C.)
- Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
| | - Tiberiu-Paul Neagu
- Department 11, Discipline Plastic and Reconstructive Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.C.)
- Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
| | - Ioan Lascar
- Department 11, Discipline Plastic and Reconstructive Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.C.)
- Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
| | - Cristian-Sorin Hariga
- Department 11, Discipline Plastic and Reconstructive Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.C.)
- Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
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Nunez J, Mironov S, Wan B, Hazime A, Clark A, Akarichi C, Abdelfattah K, Korlakunta S, Mandell S, Arnoldo B, Chan R, Goverman J, Huebinger R, Park C, Evers B, Carlson D, Berenfeld O, Levi B. Novel multi-spectral short-wave infrared imaging for assessment of human burn wound depth. Wound Repair Regen 2024; 32:979-991. [PMID: 39323286 PMCID: PMC11584362 DOI: 10.1111/wrr.13221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 05/29/2024] [Accepted: 08/30/2024] [Indexed: 09/27/2024]
Abstract
Burn depth determination is critical for patient care but is currently lacking accuracy. Recent animal studies showed that Short Wave Infrared (SWIR) imaging can distinguish between superficial and deep burns. This is a first human study correlating reflectance of multiple SWIR bands using a SWIR assessment tool (SWAT) with burn depth classifications by surgeons and histology. Burns and adjacent normal skin in 11 patients with thermal injuries were imaged with visual and narrow bands centred at 1200, 1650, 1940 and 2250 nm and biopsies were taken from select areas. Reflectance intensities for each band in 273 regions of interest (ROI) were divided by the normal skin reflectance and combined into three Reflectance Indices (RIs). In addition, burns in ROIs and biopsies were classified by five surgeons and three pathologists, respectively, as superficial partial, deep partial, or full thickness. Results show that for burn depth increase classified by the surgeons, reflectance increased at 1200 and 2250, decreased at 1940, and didn't change at 1650 nm. In contrast, all three RIs increase with burn depth and predict the deep and full depths ROIs representing operable regions (Area Under Curve >0.6507, p < 0.0001). Pathologists' classification matched surgeons' classification of burn category only in eight of 21 biopsies (38.1%), but reflectance at all bands and one RI for all deep partial and full thickness biopsies were larger than in non-biopsy normal and superficial partial thickness ROIs (p < 0.0118). In conclusion, multi-spectral imaging with a new SWAT is a promising approach for evaluation of burn wound depth.
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Affiliation(s)
- Johanna Nunez
- Department of Surgery, Center for Organogenesis, Regeneration and TraumaUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Sergey Mironov
- Department of Internal Medicine—CardiologyUniversity of MichiganAnn ArborMichiganUSA
| | - Bingchun Wan
- Department of Surgery, Center for Organogenesis, Regeneration and TraumaUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Alaa Hazime
- Department of Surgery, Center for Organogenesis, Regeneration and TraumaUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Audra Clark
- Department of Surgery, Center for Organogenesis, Regeneration and TraumaUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Chiaka Akarichi
- Department of Surgery, Center for Organogenesis, Regeneration and TraumaUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Kareem Abdelfattah
- Department of Surgery, Center for Organogenesis, Regeneration and TraumaUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Sneha Korlakunta
- Department of Surgery, Center for Organogenesis, Regeneration and TraumaUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Samuel Mandell
- Department of Surgery, Center for Organogenesis, Regeneration and TraumaUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Brett Arnoldo
- Department of Surgery, Center for Organogenesis, Regeneration and TraumaUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Rodney Chan
- Department of SurgerySan Antonio Military Medical CenterSan AntonioTexasUSA
| | - Jeremy Goverman
- Department of SurgeryMassachusetts General HospitalBostonMassachusettsUSA
| | - Ryan Huebinger
- Department of Surgery, Center for Organogenesis, Regeneration and TraumaUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Caroline Park
- Department of Surgery, Center for Organogenesis, Regeneration and TraumaUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Bret Evers
- Department of Surgery, Center for Organogenesis, Regeneration and TraumaUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Deborah Carlson
- Department of Surgery, Center for Organogenesis, Regeneration and TraumaUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Omer Berenfeld
- Department of Internal Medicine—CardiologyUniversity of MichiganAnn ArborMichiganUSA
| | - Benjamin Levi
- Department of Surgery, Center for Organogenesis, Regeneration and TraumaUniversity of Texas Southwestern Medical CenterDallasTexasUSA
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Xu J, Zhu M, Tang P, Li J, Gao K, Qiu H, Zhao S, Lan G, Jia H, Yu B. Visualization enhancement by PCA-based image fusion for skin burns assessment in polarization-sensitive OCT. BIOMEDICAL OPTICS EXPRESS 2024; 15:4190-4205. [PMID: 39022536 PMCID: PMC11249677 DOI: 10.1364/boe.521399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 05/31/2024] [Accepted: 06/01/2024] [Indexed: 07/20/2024]
Abstract
Polarization-sensitive optical coherence tomography (PS-OCT) is a functional imaging tool for measuring tissue birefringence characteristics. It has been proposed as a potentially non-invasive technique for evaluating skin burns. However, the PS-OCT modality usually suffers from high system complexity and relatively low tissue-specific contrast, which makes assessing the extent of burns in skin tissue difficult. In this study, we employ an all-fiber-based PS-OCT system with single-state input, which is simple and efficient for skin burn assessment. Multiple parameters, such as phase retardation (PR), degree of polarization uniformity (DOPU), and optical axis orientation, are obtained to extract birefringent features, which are sensitive to subtle changes in structural arrangement and tissue composition. Experiments on ex vivo porcine skins burned at different temperatures were conducted for skin burn investigation. The burned depths estimated by PR and DOPU increase linearly with the burn temperature to a certain extent, which is helpful in classifying skin burn degrees. We also propose an algorithm of image fusion based on principal component analysis (PCA) to enhance tissue contrast for the multi-parameter data of PS-OCT imaging. The results show that the enhanced images generated by the PCA-based image fusion method have higher tissue contrast, compared to the en-face polarization images by traditional mean value projection. The proposed approaches in this study make it possible to assess skin burn severity and distinguish between burned and normal tissues.
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Affiliation(s)
- Jingjiang Xu
- Guangdong-Hong Kong-Macao Intelligent Micro-Nano Optoelectronic Technology Joint Laboratory, Foshan University
, Foshan, Guangdong 528000, China
- Innovation and Entrepreneurship Teams Project of Guangdong Pearl River Talents Program, Guangdong Weiren Meditech Co., Ltd., Foshan, Guangdong 528051, China
| | - Mingtao Zhu
- School of Mechatronic Engineering and Automation, Foshan University, Foshan, Guangdong 528000, China
| | - Peijun Tang
- College of Biophotonics, South China Normal University, Guangzhou 510006, China
| | - Junyun Li
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Kai Gao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
| | - Haixia Qiu
- Department of Laser Medicine, the First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China
| | - Shiyong Zhao
- Tianjin Hengyu Medical Technology Co., Ltd., Tianjin 300000, China
| | - Gongpu Lan
- Guangdong-Hong Kong-Macao Intelligent Micro-Nano Optoelectronic Technology Joint Laboratory, Foshan University
, Foshan, Guangdong 528000, China
- Innovation and Entrepreneurship Teams Project of Guangdong Pearl River Talents Program, Guangdong Weiren Meditech Co., Ltd., Foshan, Guangdong 528051, China
| | - Haibo Jia
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, China
| | - Bo Yu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, China
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Jiang Z, Wu J, Qiu Y, Shen G. Perfusion Analysis Using High-Definition Indocyanine Green Angiography in Burn Comb Model. J Burn Care Res 2024; 45:373-383. [PMID: 37830308 DOI: 10.1093/jbcr/irad156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Indexed: 10/14/2023]
Abstract
Indocyanine green angiography (ICGA) has been widely employed for quantitative evaluation of the rat comb burn model, but the imaging equipment, imaging protocol, and fluorescence data interpretation of ICGA remain unsatisfactory. This study aims to provide better solutions for the application of ICGA in perfusion analysis. The rat comb burn model was established under a series of different comb contact durations, including 10, 20, 25, 30, 35, and 40 s. Indocyanine green angiography was used to analyze wound perfusion. In total, 16 rats were divided into ibuprofen and control groups for the burn model, and their perfusion was compared. A total of 16 identical models were divided into standard- and high-dose indocyanine green (ICG) groups, and ICGA was conducted to investigate the dynamic change in wound fluorescence. Escharectomy was performed under real-time fluorescence mapping and navigation. The results showed that a comb contact duration of 30 s was optimum for the burn model. Indocyanine green angiography could accurately evaluate the histologically determined depth of thermal injury and wound perfusion in the rat comb model. Digital subtraction of residual fluorescence was necessary for multiple comparisons of perfusion. Dynamic changes in fluorescence and necrotic tissues were observed more clearly by high-dose (0.5 mg/kg) ICG in angiography. In conclusion, perfusion analysis by ICGA can be used to assess the histologically determined depth of thermal injury and the impact of a specific treatment on wound perfusion. Indocyanine green angiography can help to identify necrotic tissue. The above findings and related imaging protocols lay the foundation for future research.
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Affiliation(s)
- Zhaolong Jiang
- Department of Burn and Plastic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
- Department of Burn and Plastic Surgery, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Junqiang Wu
- Department of Breast Surgery, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Yunjie Qiu
- Department of Medical Statistics, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Guoliang Shen
- Department of Burn and Plastic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
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Khalaf MH, Abdelrahman H, El-Menyar A, Afifi I, Kloub A, Al-Hassani A, Rizoli S, Al-Thani H. Utility of indocyanine green fluorescent dye in emergency general surgery: a review of the contemporary literature. Front Surg 2024; 11:1345831. [PMID: 38419940 PMCID: PMC10899482 DOI: 10.3389/fsurg.2024.1345831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
For decades, indocyanine green (ICG) has been available for medical and surgical use. The indications for ICG use in surgery have expanded where guided surgery directed by fluorescence and near-infrared fluorescent imaging offers numerous advantages. Recently, surgeons have reported using ICG operative navigation in the emergency setting, with fluorescent cholangiography being the most common procedure. The utility of ICG also involves real-time perfusion assessment, such as ischemic organs and limbs. The rising use of ICG in surgery can be explained by the ICG's rapid technological evolution, accuracy, ease of use, and great potential to guide precision surgical diagnosis and management. The review aims to summarize the current literature on the uses of ICG in emergency general surgery. It provides a comprehensive and practical summary of the use of ICG, including indication, route of administration, and dosages. To simplify the application of ICG, we subdivided its use into anatomical mapping and perfusion assessment. Anatomical mapping includes the biliary tree, ureters, and bowel. Perfusion assessment includes bowel, pancreas, skin and soft tissue, and gonads. This review provides a reference to emergency general surgeons to aid in implementing ICG in the emergency setting for more enhanced and safer patient care.
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Affiliation(s)
| | - Husham Abdelrahman
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Ayman El-Menyar
- Clinical Research, Trauma & Vascular Surgery Section, Hamad Medical Corporation, Doha, Qatar
- Department of Clinical Medicine, Weill Cornell Medicine, Doha, Qatar
| | - Ibrahim Afifi
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Ahmad Kloub
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Ammar Al-Hassani
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Sandro Rizoli
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
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Greenhalgh DG. Operative Management of Burns: Traditional Care. EUROPEAN BURN JOURNAL 2023; 4:262-279. [PMID: 39599933 PMCID: PMC11571865 DOI: 10.3390/ebj4020024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/24/2023] [Accepted: 06/13/2023] [Indexed: 11/29/2024]
Abstract
Surgical treatment of burn wounds has had a tremendous impact on burn patients. The survival of patients with massive burns is now very common. Expeditious coverage of the wound has been a major contributor to improved survival, but survival is not enough. There is a need to improve the ultimate functional and cosmetic outcomes of the wound in order to facilitate a patient's return to society. This paper reviews strategies, using fairly basic techniques, to optimize the outcomes of burn patients. While there are many new skin products available, the strategies presented here can apply to any surgeon treating burns throughout the entire world.
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Affiliation(s)
- David G. Greenhalgh
- Burn Department, Shriners Children’s Northern California, 2425 Stockton Blvd., Sacramento, CA 95817, USA; ; Tel.: +1-916-453-2050
- Department of Surgery, University of California, Davis, Sacramento, CA 95817, USA
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Abdelrahman H, El-Menyar A, Peralta R, Al-Thani H. Application of indocyanine green in surgery: A review of current evidence and implementation in trauma patients. World J Gastrointest Surg 2023; 15:757-775. [PMID: 37342859 PMCID: PMC10277941 DOI: 10.4240/wjgs.v15.i5.757] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/18/2023] [Accepted: 03/27/2023] [Indexed: 05/26/2023] Open
Abstract
Background: Modern surgical medicine strives to manage trauma while improving outcomes using functional imaging. Identification of viable tissues is crucial for the surgical management of polytrauma and burn patients presenting with soft tissue and hollow viscus injuries. Bowel anastomosis after trauma-related resection is associated with a high rate of leakage. The ability of the surgeon’s bare eye to determine bowel viability remains limited, and the need for a more standardized objective assessment has not yet been fulfilled. Hence, there is a need for more precise diagnostic tools to enhance surgical evaluation and visualization to aid early diagnosis and timely management to minimize trauma-associated complications. Indocyanine green (ICG) coupled with fluorescence angiography is a potential solution for this problem. ICG is a fluorescent dye that responds to near-infrared irradiation. Methods: We conducted a narrative review to address the utility of ICG in the surgical management of patients with trauma as well as elective surgery. Discussion: ICG has many applications in different medical fields and has recently become an important clinical indicator for surgical guidance. However, there is a paucity of information regarding the use of this technology to treat traumas. Recently, angiography with ICG has been introduced in clinical practice to visualize and quantify organ perfusion under several conditions, leading to fewer cases of anastomotic insufficiency. This has great potential to bridge this gap and enhance the clinical outcomes of surgery and patient safety. However, there is no consensus on the ideal dose, time, and manner of administration nor the indications that ICG provides a genuine advantage through greater safety in trauma surgical settings. Conclusions: There is a scarcity of publications describing the use of ICG in trauma patients as a potentially useful strategy to facilitate intraoperative decisions and to limit the extent of surgical resection. This review will improve our understanding of the utility of intraoperative ICG fluorescence in guiding and assisting trauma surgeons to deal with the intraoperative challenges and thus improve the patients’ operative care and safety in the field of trauma surgery.
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Affiliation(s)
| | - Ayman El-Menyar
- Trauma and Vascular Surgery, Hamad Medical Corporation, Doha 3050, Qatar
| | - Ruben Peralta
- Trauma Surgery, Hamad Medical Corporation, Doha 3050, Qatar
| | - Hassan Al-Thani
- Trauma and Vascular Surgery, Hamad Medical Corporation, Doha 3050, Qatar
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Zajac JC, Liu A, Uselmann AJ, Lin C, Hassan SE, Faucher LD, Gibson ALF. Lighting the Way for Necrosis Excision Through Indocyanine Green Fluorescence-Guided Surgery. J Am Coll Surg 2022; 235:743-755. [PMID: 36102554 PMCID: PMC9753148 DOI: 10.1097/xcs.0000000000000329] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND No objective technique exists to distinguish necrotic from viable tissue, risking over-excision in burns and loss of wound healing potential. Second window indocyanine green (SWIG) is a novel fluorescence-imaging modality being studied to identify residual solid tumors during oncological surgery. SWIG has also been shown to have avidity for necrosis in animal models, but translation of these findings to humans is lacking. The objective of this study was to evaluate SWIG in the identification of burn wound necrosis and compare it with previously published indocyanine green angiography (ICGA) techniques. STUDY DESIGN This study used mouse, human skin xenograft and human patient burn models. Brightfield and SWIG near-infrared imaging were performed on macroscopic tissue samples, which were then cryopreserved, sectioned, and analyzed for microscopic fluorescence. SWIG fluorescence findings were correlated to visual assessment of the burn wound as well as histological markers of necrosis using hematoxylin and eosin and lactate dehydrogenase stains. RESULTS We found that SWIG identified burn necrosis in a manner dependent on the dose and timing of indocyanine green (ICG) administration and had an inverse fluorescence signal compared with ICGA. Furthermore, SWIG fluorescence identified the interface of viable and nonviable tissue. CONCLUSION Our study confirmed that ICGA is an inconsistent and nonstandardized modality to evaluate burn injuries. In contrast, SWIG imaging is a potential imaging modality to objectively prognosticate burn wound healing potential and guide intraoperative burn excision. Further studies are needed to define ratios of fluorescence intensity values to guide surgical decision-making in burn excision and to better define how ICG is retained in necrotic tissue to enhance utility of SWIG in other disease processes.
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Affiliation(s)
- Jocelyn C Zajac
- Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Aiping Liu
- Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | | | | | - Sameeha E Hassan
- Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Lee D Faucher
- Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Angela LF Gibson
- Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
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Asif A, Poyiatzis C, Raheman FJ, Rojoa DM. The Use of Infrared Thermography (IRT) in Burns Depth Assessment: A Diagnostic Accuracy Meta-Analysis. EUROPEAN BURN JOURNAL 2022; 3:432-446. [PMID: 39599957 PMCID: PMC11571867 DOI: 10.3390/ebj3030038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/17/2022] [Accepted: 06/17/2022] [Indexed: 11/29/2024]
Abstract
BACKGROUND The timely diagnosis of burns depth is crucial to avoid unnecessary surgery and delays in adequate management of patients with burn injuries. Whilst it is mostly a clinical diagnosis, indocyanine green, laser Doppler imaging and infrared thermography have been used alongside clinical findings to support the diagnosis. Infrared thermography is a noninvasive technique which uses temperature differences to diagnose tissue burn depth. Our study aims to assess its use in differentiating between superficial and deep burns. METHODS We conducted a systematic literature review and meta-analysis using electronic databases. We used a mixed-effects logistic regression bivariate model to estimate summary sensitivity and specificity and developed hierarchical summary receiver operating characteristic (HSROC) curves. RESULTS We identified 6 studies reporting a total of 197 burns, of which 92 were proven to be deep burns. The reference standard was clinical assessment at the time of injury and burn healing time. The pooled estimates for sensitivity and specificity were 0.84 (95% CI 0.71-0.92) and 0.76 (95% CI 0.56-0.89), respectively. CONCLUSIONS IRT is a promising burns assessment modality which may allow surgeons to correctly classify burn injuries at the time of presentation. This will allow a more efficient management of burns and timely surgical intervention.
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Affiliation(s)
- Aqua Asif
- George Davies Centre, Leicester Medical School, University of Leicester, Lancaster Rd., Leicester LE1 7HA, UK
| | - Constantinos Poyiatzis
- George Davies Centre, Leicester Medical School, University of Leicester, Lancaster Rd., Leicester LE1 7HA, UK
| | - Firas J. Raheman
- East and North Hertforshire NHS Trust, Coreys Mill Lane, Stevenage SG1 4AB, UK
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10
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Yin M, Li Y, Luo Y, Yuan M, Armato U, Prà ID, Zhang L, Zhang D, Wei Y, Yang G, Huang L, Wang P, Wu J. A novel method for objectively, rapidly and accurately evaluating burn depth via near infrared spectroscopy. BURNS & TRAUMA 2021; 9:tkab014. [PMID: 34258302 PMCID: PMC8272531 DOI: 10.1093/burnst/tkab014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/27/2020] [Indexed: 11/13/2022]
Abstract
The accurate and objective evaluation of burn depth is a significant challenge in burn wound care. Herein, we used near infrared spectroscopy (NIRS) technology to measure the different depth of thermal burns in ex vivo porcine models. Based on the intensity of the spectral signals and the diffuse reflection theory, we extracted the optical parameters involved in functional (total hemoglobin and water content) and structural (tissue scattered size and scattered particles) features that reflect the changes in burn depth. Next, we applied support vector regression to construct a model including the optical property parameters and the burn depth. Finally, we histologically verified the burn depth data collected via NIRS. The results showed that our inversion model could achieve an average relative error of about 7.63%, while the NIRS technology diagnostic accuracy was in the range of 50 μm. For the first time, this novel technique provides physicians with real-time burn depth information objectively and accurately.
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Affiliation(s)
- Meifang Yin
- Department of Burn and Plastic Surgery, Institute Translational Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen 518035, China
| | - Yongming Li
- School of Microelectronics and Communication Engineering, Chongqing University, Chongqing 400044, China
| | - Yongquan Luo
- Institute of Fluid Physics, China Academy of Engineering Physics, Mianyang, Sichuan 621900, China
| | - Mingzhou Yuan
- Department of Burn Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Ubaldo Armato
- Department of Burn and Plastic Surgery, Institute Translational Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen 518035, China
| | - Ilaria Dal Prà
- Human Histology & Embryology Section, Department of Surgery, Dentistry, Pediatrics & Gynecology, University of Verona Medical School, Strada Le Grazie 8, Verona 37134, Italy
| | - Lijun Zhang
- Department of Burn and Plastic Surgery, Institute Translational Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen 518035, China
| | - Dayong Zhang
- Institute of Fluid Physics, China Academy of Engineering Physics, Mianyang, Sichuan 621900, China
| | - Yating Wei
- Department of Burn and Plastic Surgery, Institute Translational Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen 518035, China
| | - Guang Yang
- Department of Burn and Plastic Surgery, Institute Translational Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen 518035, China
| | - Lixian Huang
- Institute of Fluid Physics, China Academy of Engineering Physics, Mianyang, Sichuan 621900, China
| | - Pin Wang
- School of Microelectronics and Communication Engineering, Chongqing University, Chongqing 400044, China
| | - Jun Wu
- Department of Burn and Plastic Surgery, Institute Translational Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen 518035, China
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11
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Wongkietkachorn A, Surakunprapha P, Jenwitheesuk K, Eua-angkanakul K, Winaikosol K, Punyavong P, Wongkietkachorn N, Wongkietkachorn S, Salyapongse AN. Indocyanine Green Angiography Precise Marking for Indeterminate Burn Excision: A Prospective, Multi-centered, Double-blinded Study. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3538. [PMID: 33868880 PMCID: PMC8049159 DOI: 10.1097/gox.0000000000003538] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/10/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND During burn excision, the clinical judgment whether to excise or not excise the area with indeterminate burn depth is difficult. Indocyanine green angiography (ICGA) has been reported to provide high accuracy in diagnosing indeterminate burns. This study aims to evaluate the complete wound closures in both short-term and long-term outcomes after using ICGA precise marking to guide indeterminate burn excision. METHODS This was a prospective, multi-centered, double-blinded, experimental study. The participants were admitted to the hospital with indeterminate burn wounds. ICGA precise marking was performed. The deep second-degree burn was painted, excised, and subsequently covered with skin grafts and measured on day 5. The superficial burns were measured on day 21. All wounds were followed-up at two months. RESULTS Thirty indeterminate burn sites were included in this study. Using ICGA precise marking, the overall rate of short-term complete wound closure, which combined superficial and deep burns, was found to be as high as 96.7% (29/30). The long-term complete wound closures at two months confirmed the short-term result and yielded 100.0% of complete wound closure. The complete wound closures between the short-term and long-term measurements were not significantly different (P > 0.999). CONCLUSIONS Using ICGA precise marking to guide indeterminate burn excision resulted in an excellent rate of complete wound closure and an insignificant difference between short-term and long-term wound outcomes. ICGA is a competent method to aid decision-making in burn surgery of the indeterminate area.
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Affiliation(s)
- Apinut Wongkietkachorn
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Palakorn Surakunprapha
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kamonwan Jenwitheesuk
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kant Eua-angkanakul
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Khon Kaen Hospital, Khon Kaen, Thailand
| | - Kengkart Winaikosol
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Pattama Punyavong
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Supawich Wongkietkachorn
- Department of Surgery, Faculty of Medicine, Princess Naradhiwas University, Naradhiwas, Thailand
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12
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An Inconvenient Truth of Clinical Assessment and Indocyanine Green Angiography Precise Marking for Indeterminate Burn Excision. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3497. [PMID: 33777602 PMCID: PMC7989992 DOI: 10.1097/gox.0000000000003497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 01/26/2021] [Indexed: 11/26/2022]
Abstract
Background: The clinical assessment of indeterminate burn wounds has relatively poor accuracy. Indocyanine green angiography (ICGA) has high accuracy and can be used to mark wounds precisely so as to guide burn excision. This study aimed to assess the differences between ICGA and clinical assessment marking and compare the marking result with the long-term wound outcome. Methods: This was a prospective, multicentered, triple-blinded, experimental study. Indeterminate burn wounds were clinically assessed, and the area to be excised was firstly marked by the attending surgeon. ICGA marking was then performed by a second surgeon. Measurement of the marked area was conducted by a third surgeon. Three surgeons were each blinded to the others' processes. The wounds were followed up to assess complete wound closures on day 21. Results: There were 20 burn sites included in the study. There was a significant difference in the marked areas between clinical assessment and ICGA (mean, 57.3 ± 44.1%; P = 0.001). The maximum difference found was as high as 160.9%. The correction rate of ICGA marking to complete wound closure on day 21 was 95.0%. Over 90% of the decreased areas of excision—which were assessed by ICGA to be superficial burns but evaluated by clinical assessment to be deep burns—were completely healed on day 21. Conclusions: ICGA contributes to a significant difference versus clinical assessment in the marking for excision of indeterminate burns and strongly associates with long-term wound outcomes. The burn wounds can be assessed precisely to reduce unnecessary excision and prevent inadequate excision.
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13
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Jagtap J, Audi S, Razeghi-Kondelaji MH, Fish BL, Hansen C, Narayan J, Gao F, Sharma G, Parchur AK, Banerjee A, Bergom C, Medhora M, Joshi A. A rapid dynamic in vivo near-infrared fluorescence imaging assay to track lung vascular permeability after acute radiation injury. Am J Physiol Lung Cell Mol Physiol 2021; 320:L436-L450. [PMID: 33404364 DOI: 10.1152/ajplung.00066.2020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
To develop a dynamic in vivo near-infrared (NIR) fluorescence imaging assay to quantify sequential changes in lung vascular permeability-surface area product (PS) in rodents. Dynamic NIR imaging methods for determining lung vascular permeability-surface area product were developed and tested on non-irradiated and 13 Gy irradiated rats with/without treatment with lisinopril, a radiation mitigator. A physiologically-based pharmacokinetic (PBPK) model of indocyanine green (ICG) pulmonary disposition was applied to in vivo imaging data and PS was estimated. In vivo results were validated by five accepted assays: ex vivo perfused lung imaging, endothelial filtration coefficient (Kf) measurement, pulmonary vascular resistance measurement, Evan's blue dye uptake, and histopathology. A PBPK model-derived measure of lung vascular permeability-surface area product increased from 2.60 ± 0.40 [CL: 2.42-2.78] mL/min in the non-irradiated group to 6.94 ± 8.25 [CL: 3.56-10.31] mL/min in 13 Gy group after 42 days. Lisinopril treatment lowered PS in the 13 Gy group to 4.76 ± 6.17 [CL: 2.12-7.40] mL/min. A much higher up to 5× change in PS values was observed in rats exhibiting severe radiation injury. Ex vivo Kf (mL/min/cm H2O/g dry lung weight), a measure of pulmonary vascular permeability, showed similar trends in lungs of irradiated rats (0.164 ± 0.081 [CL: 0.11-0.22]) as compared to non-irradiated controls (0.022 ± 0.003 [CL: 0.019-0.025]), with reduction to 0.070 ± 0.035 [CL: 0.045-0.096] for irradiated rats treated with lisinopril. Similar trends were observed for ex vivo pulmonary vascular resistance, Evan's blue uptake, and histopathology. Our results suggest that whole body dynamic NIR fluorescence imaging can replace current assays, which are all terminal. The imaging accurately tracks changes in PS and changes in lung interstitial transport in vivo in response to radiation injury.
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Affiliation(s)
- Jaidip Jagtap
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Said Audi
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, Wisconsin.,Department of Biomedical Engineering, Marquette University, Milwaukee, Wisconsin
| | | | - Brian L Fish
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Christopher Hansen
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jayashree Narayan
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Feng Gao
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Gayatri Sharma
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Abdul K Parchur
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Anjishnu Banerjee
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Carmen Bergom
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin.,Department of Pharmacology and Toxicology, Medical College of Wisconsin, Milwaukee, Wisconsin.,Cancer Center, Medical College of Wisconsin, Milwaukee, Wisconsin.,Cardiovascular Center, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Meetha Medhora
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin.,Cardiovascular Center, Medical College of Wisconsin, Milwaukee, Wisconsin.,Department of Pulmonary Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Amit Joshi
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, Wisconsin.,Department of Biomedical Engineering, Marquette University, Milwaukee, Wisconsin
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14
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Cheng Z, Ma H, Wang Z, Yang S. In vivo volumetric monitoring of revascularization of traumatized skin using extended depth-of-field photoacoustic microscopy. FRONTIERS OF OPTOELECTRONICS 2020; 13:307-317. [PMID: 36641563 PMCID: PMC9743921 DOI: 10.1007/s12200-020-1040-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 05/27/2020] [Indexed: 05/08/2023]
Abstract
Faster and better wound healing is a critical medical issue. Because the repair process of wounds is closely related to revascularization, accurate early assessment and postoperative monitoring are very important for establishing an optimal treatment plan. Herein, we present an extended depth-of-field photoacoustic microscopy system (E-DOF-PAM) that can achieve a constant spatial resolution and relatively uniform excitation efficiency over a long axial range. The superior performance of the system was verified by phantom and in vivo experiments. Furthermore, the system was applied to the imaging of normal and trauma sites of volunteers, and the experimental results accurately revealed the morphological differences between the normal and traumatized skin of the epidermis and dermis. These results demonstrated that the E-DOF-PAM is a powerful tool for observing and understanding the pathophysiology of cutaneous wound healing.
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Affiliation(s)
- Zhongwen Cheng
- MOE Key Laboratory of Laser Life Science & Institute of Laser Life Science, College of Biophotonics, South China Normal University, Guangzhou, 510631, China
| | - Haigang Ma
- Guangdong Provincial Key Laboratory of Laser Life Science, College of Biophotonics, South China Normal University, Guangzhou, 510631, China
| | - Zhiyang Wang
- Guangdong Provincial Key Laboratory of Laser Life Science, College of Biophotonics, South China Normal University, Guangzhou, 510631, China
| | - Sihua Yang
- MOE Key Laboratory of Laser Life Science & Institute of Laser Life Science, College of Biophotonics, South China Normal University, Guangzhou, 510631, China.
- Guangdong Provincial Key Laboratory of Laser Life Science, College of Biophotonics, South China Normal University, Guangzhou, 510631, China.
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15
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Wongkietkachorn A, Surakunprapha P, Winaikosol K, Eua-Angkanakul K, Wongkietkachorn N, Punyavong P, Jenwitheesuk K, Chowchuen B, Wongkietkachorn S. Quantitative Burn Depth Analysis Using Indocyanine Green Angiography. J Burn Care Res 2020; 40:725. [PMID: 31181142 DOI: 10.1093/jbcr/irz090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Apinut Wongkietkachorn
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, Mae Fah Luang University, Chiang Rai, Thailand
| | - Palakorn Surakunprapha
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kengkart Winaikosol
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kant Eua-Angkanakul
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Khon Kaen Hospital, Khon Kaen, Thailand
| | | | - Pattama Punyavong
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kamonwan Jenwitheesuk
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Bowornsilp Chowchuen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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16
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Paint It Blue: Methylene Blue in Burn Care. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3079. [PMID: 33173662 PMCID: PMC7647647 DOI: 10.1097/gox.0000000000003079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 11/25/2022]
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17
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Schroeder AB, Karim A, Ocotl E, Dones JM, Chacko JV, Liu A, Raines RT, Gibson ALF, Eliceiri KW. Optical imaging of collagen fiber damage to assess thermally injured human skin. Wound Repair Regen 2020; 28:848-855. [PMID: 32715561 DOI: 10.1111/wrr.12849] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 05/15/2020] [Accepted: 06/22/2020] [Indexed: 12/12/2022]
Abstract
Surgery is the definitive treatment for burn patients who sustain full-thickness burn injuries. Visual assessment of burn depth is made by the clinician early after injury but is accurate only up to 70% of the time among experienced surgeons. Collagen undergoes denaturation as a result of thermal injury; however, the association of collagen denaturation and cellular death in response to thermal injury is unknown. While gene expression assays and histologic staining allow for ex vivo identification of collagen changes, these methods do not provide spatial or integrity information in vivo. Thermal effects on collagen and the role of collagen in wound repair have been understudied in human burn models due to a lack of methods to visualize both intact and denatured collagen. Hence, there is a critical need for a clinically applicable method to discriminate between damaged and intact collagen fibers in tissues. We present two complementary candidate methods for visualization of collagen structure in three dimensions. Second harmonic generation imaging offers a label-free, high-resolution method to identify intact collagen. Simultaneously, a fluorophore-tagged collagen-mimetic peptide can detect damaged collagen. Together, these methods enable the characterization of collagen damage in human skin biopsies from burn patients, as well as ex vivo thermally injured human skin samples. These combined methods could enhance the understanding of the role of collagen in human wound healing after thermal injury and potentially assist in clinical decision-making.
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Affiliation(s)
- Alexandra B Schroeder
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Medical Engineering, Morgridge Institute for Research, Madison, Wisconsin, USA.,Laboratory for Optical and Computational Instrumentation, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Aos Karim
- Department of Surgery, University of Wisconsin-Madison Hospitals and Clinics, Madison, Wisconsin, USA
| | - Edgar Ocotl
- Department of Surgery, University of Wisconsin-Madison Hospitals and Clinics, Madison, Wisconsin, USA
| | - Jesús M Dones
- Department of Chemistry, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Jenu V Chacko
- Laboratory for Optical and Computational Instrumentation, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Aiping Liu
- Department of Surgery, University of Wisconsin-Madison Hospitals and Clinics, Madison, Wisconsin, USA
| | - Ronald T Raines
- Department of Chemistry, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Angela L F Gibson
- Department of Surgery, University of Wisconsin-Madison Hospitals and Clinics, Madison, Wisconsin, USA
| | - Kevin W Eliceiri
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Medical Engineering, Morgridge Institute for Research, Madison, Wisconsin, USA.,Laboratory for Optical and Computational Instrumentation, University of Wisconsin-Madison, Madison, Wisconsin, USA
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18
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19
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Muntean MV, Strilciuc S, Muntean V. Reply to letter to the editor regarding article "Flap warming improves intraoperative indocyanine green angiography (ICGA) assessment of perfusion. An experimental study" by Muntean et al. J Plast Reconstr Aesthet Surg 2019; 73:608-620. [PMID: 31879257 DOI: 10.1016/j.bjps.2019.11.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 11/22/2019] [Indexed: 10/25/2022]
Affiliation(s)
- M V Muntean
- Department of Plastic Surgery, University of Medicine and Pharmacy "Iuliu Hatieganu", No. 8 Victor Babes Street, Cluj-Napoca 400012, Romania
| | - S Strilciuc
- Department of Neurosciences, University of Medicine and Pharmacy "Iuliu Hatieganu", No. 8 Victor Babes Street, Cluj-Napoca 400012, Romania; RoNeuro Institute for Neurological Research and Diagnostic, No. 37 Mircea Eliade Street, Cluj-Napoca 400486, Romania.
| | - V Muntean
- Department of Surgery, University of Medicine and Pharmacy "Iuliu Hatieganu", No. 8 Victor Babes Street, Cluj-Napoca 400012, Romania
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