A simplified three-dimensional volume measurement technique in keloid scars: Validity and reliability

A three-dimensional scar assessment tool for keloid scars: Volume, erythema and melanin quantified

BACKGROUND

There is no non-invasive objective assessment tool to measure keloid scar characteristics over time. This study aimed to ascertain the ability of the Antera 3D^® camera to detect differences in keloid features pre- and post-steroid injection. In order to identify whether those variation could be considered as treatment response predicting factors.

METHODS

Enrolled patients received three intra-lesional steroid injections at four-weekly intervals. Images were taken with the Antera 3D camera 12 and 24 weeks after treatment. Keloids' colour, volume, and area as well as haemoglobin and melanin average levels and variation have been analysed pre- and post-steroid injection. t Tests and relative risk have been used to analyse the significance and association strength of our finding.

RESULTS

Forty patients have been enrolled in the study. Significant changes as been recorded in keloids' volume and colour after steroid injection (P < 0.05). 53% have recorded a Hb reduction showing no recurrence of pathology, patient who had increase in Hb showed an early recurrence. Melanin variation was significant after steroid injection (P < 0.05) but no correlation has been found with treatment response.

CONCLUSIONS

The Antera 3D camera is able to detect differences in the investigated keloid's features helping in two ways: by providing an objective, longitudinal method to monitor and document changes in scar morphology, and through monitoring haemoglobin change, which strongly correlates to both response to treatment and likelihood of recurrence. Allowing clinicians to identify which patients will respond early, in order to change treatment if necessary, limiting morbidity and costs.

Dermatologic Scar Assessment With Stereoscopic Imaging and Digital Three-Dimensional Models: A Validation Study

BACKGROUND AND OBJECTIVE

We evaluated a new handheld stereoscopic imaging system capable of visualizing scars with digital three-dimensional (3D) models and providing automated morphometric estimates. The objective was to validate the repeatability and accuracy of intra- and inter-investigator scan results.

STUDY DESIGN/MATERIALS AND METHODS

Engineered metal plates with depressed and elevated model scars (n = 72) were scanned six times by one investigator. In vivo hypertrophic and atrophic scars (n = 15) were scanned once by three investigators. The repeatability of morphometric estimates was assessed using coefficients of variation (CVs) to compare the variation among multiple scan results for both models and in vivo scars, with 0% reflecting a perfect match. Scar estimates from digital 3D reconstructions were compared with the known dimensions of physical model scars and with ruler measurements of in vivo scars.

RESULTS

A total of 48 model scars and 12 in vivo scars were eligible for automated analyses with the imaging system's proprietary software. Intra-investigator scan results for the model scars were repeatable, with low variance for all parameters: volume, area, length, and depth/height (CV: 1.8-3.1%). By comparison, inter-investigator scans of real in vivo scars resulted in slightly higher median CVs (4.4-7.3%; P < 0.05). 3D model scar estimates correlated well with the known physical dimensions of model scars for all parameters (P < 0.001) and accurately reflected the measurements of in vivo scars (P < 0.001). The six in vivo scars situated on the chest and abdomen showed the highest inter-investigator variation, due to respiratory movement artifacts.

CONCLUSION

Stereoscopic imaging of scars generates accurate and repeatable measurement estimates that show little intra- and inter-investigator-based assessment variation. The best results are achieved by minimizing subject movement. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

Assessing keloid recurrence following surgical excision and radiation

Keloids are a fibroproliferative disorder that can result from a cutaneous injury to the reticular dermis. Recurrence rates as high as 100% have been reported following surgical excision alone. Consequently, a variety of post-surgical techniques have been employed to prevent keloid recurrence, including the use of radiation. Although numerous studies have shown post-excisional X-rays, electron beam, lasers and brachytherapy can reduce the rate of keloid recurrence, numerous inconsistencies, including a wide range of definitions for keloid recurrence, make it difficult to compare study outcomes. The review aims to examine the various means for defining keloid recurrence in clinical trials involving the use of radiation therapy. Searches of the Cochrane Library and PubMed were performed to identify the available information for post-surgical keloid recurrence following radiation therapy. Each identified study was reviewed for patient follow-up and criteria used to define keloid recurrence. The search results included clinical studies with external beam radiation, brachytherapy and superficial radiation therapy. Many studies did not include a definition of keloid recurrence, or defined recurrence only as the return of scar tissue. Other studies defined keloid recurrence based on patient self-assessment questionnaires, symptoms and scar elevation and changes in Kyoto Scar Scale, Japan Scar Workshop Scale and Vancouver Scar Scale scores. The results of this review indicate keloidectomy followed by radiation therapy provide satisfactory recurrence rates; however, clinical studies evaluating these treatments do not describe treatment outcomes or use different definitions of keloid recurrence. Consequently, recurrence rates vary widely, making comparisons across studies difficult. Keloid recurrence should be clearly defined using both objective and subjective measures.

Use of a smartphone for imaging, modelling, and evaluation of keloids

OBJECTIVE

We used a smartphone to construct three-dimensional (3D) models of keloids, then quantitatively simulate and evaluate these tissues.

METHODS

We uploaded smartphone photographs of 33 keloids on the chest, shoulder, neck, limbs, or abdomen of 28 patients. We used the parallel computing power of a graphics processing unit to calculate the spatial co-ordinates of each pixel in the cloud, then generated 3D models. We obtained the longest diameter, thickness, and volume of each keloid, then compared these data to findings obtained by traditional methods.

RESULTS

Measurement repeatability was excellent: intraclass correlation coefficients were 0.998 for longest diameter, 0.978 for thickness, and 0.993 for volume. When measuring the longest diameter and volume, the results agreed with Vernier caliper measurements and with measurements obtained after the injection of water into the cavity. When measuring thickness, the findings were similar to those obtained by ultrasound. Bland-Altman analyses showed that the ratios of 95% confidence interval extremes were 3.03% for longest diameter, 3.03% for volume, and 6.06% for thickness.

CONCLUSION

Smartphones were used to acquire data that was then employed to construct 3D models of keloids; these models yielded quantitative data with excellent reliability and validity. The smartphone can serve as an additional tool for keloid diagnosis and research, and will facilitate medical treatment over the internet.

Incorporation of 3D stereophotogrammetry as a reliable method for assessing scar volume in standard clinical practice

Significant disfigurement and dysfunction is caused by hypertrophic scarring, a prevalent complication of burn wounds. A lack of objective tools in the assessment of scar parameters makes evaluation of scar treatment modalities difficult. 3D stereophotogrammetry, obtaining measurements from 3D photographs, represents a method to quantitate scar volume, and a 3D camera may have use in clinical practice. To validate this method, scar models were created and photographed with a 3D camera. Measurements from 3D image analysis of these scar models were compared to physical measurements of scar model volume. Reliability of 3D image analysis was assessed with both scar models and burn patient scars. Measurements of scar models by two independent observers were compared to determine inter-rater reliability, and measurements from 3D images of burn patient hypertrophic scars were compared to determine the consistency of the method between observers. The time taken for patient photography was recorded. No significant differences were found between the two methods of volume calculation (p = 0.89), and a plot of the differences showed agreement between the methods. The correlation coefficient between the two observers' measurements of scar model volume was 0.92, and the intra-class correlation coefficient for patient scar volume was 0.998, showing good reliability. The time required to capture 3D photographs ranged from 2 to 6 min per patient, showing the potential for this tool to be efficiently incorporated into clinical practice. 3D stereophotogrammetry is a valid method to reliably measure scar volume and may be used to objectively measure efficacy of scar treatment modalities to track scar development and resolution.

Validity and Reliability of Three-Dimensional Imaging for Measuring Breast Cancer-Related Lymphedema in the Upper Limb: A Cross-Sectional Study

Background: In the past, measurement of upper limb lymphedema was done by water displacement (WD), which is frequently cited as the gold standard. For various reasons, however, the use of WD is restricted in clinical settings. A more precise and easy-to-use method would be favorable. The high precision of three-dimensional (3D) imaging in comparison to WD has already been reported for healthy subjects. The aim of this study is to determine the validity and reliability of 3D imaging by comparing it to the WD method in women with unilateral upper limb lymphedema. Methods and Results: Thirty-nine women with unilateral breast cancer-related lymphedema (BCRL) were included, of which 37 completed two volume measurement techniques (3D and WD) on the BCRL and contralateral healthy arm. Slightly larger volumes were measured by the WD method in healthy arms (+9.8 mL; p = 0.058) and also in BCRL arms (+18.5 mL; p < 0.001). All measurements were performed twice by the same researcher to evaluate reliability. There was no significant difference between the two measurements for healthy arms (p = 0.323) or BCRL arms (p = 0.807) in 3D imaging. Bland-Altman plots showed a high limit of agreement between the single measurements. 3D imaging had a high intrarater reliability (Intraclass Correlation Coefficient = 0.999). Conclusion: Results show that 3D imaging is an innovative method for measuring upper limb volume in BCRL patients. Even though image processing is time consuming, 3D imaging combines high reproducibility with high precision. By software automation, this technique could easily be integrated into clinical routine. It is for this reason that we would recommend implementing the Vectra 3D imaging technique for measurement of BCRL.

Preventive effect of polynucleotide on post-thyroidectomy scars: A randomized, double-blinded, controlled trial

BACKGROUND AND OBJECTIVE

Polynucleotide (PN) provides a structural scaffold to induce anti-inflammatory and enhanced wound healing properties, and this study aimed to assess the efficacy of PN administration in the prevention of post-operative scars after conventional open total thyroidectomy.

STUDY DESIGN MATERIALS AND METHODS

Forty-two patients with thyroid carcinoma who underwent total thyroidectomy were randomly assigned to the study (PN administration) or control (normal saline) group. All patients underwent a single session of combined ablative and non-ablative fractional laser. The Vancouver Scar Scale (VSS), global photographic assessment, and objective scar were assessed using three-dimensional (3D) camera at baseline and at 2, 4, 8, and 16 weeks after surgery.

RESULTS

Patients who underwent PN injection demonstrated better surgical scar quality outcome. Participants in the PN administration group had lower VSS scores than the control group (2.09 ± 0.47 vs. 4.01 ± 0.55, respectively) and lower scar height (0.23 ± 0.03 vs. 0.29 ± 0.03, respectively), as measured using 3D imaging. Furthermore, in the PN injected group, the degree of erythema, and pigmentation of the scar were less prominent. No patient developed hypertrophic scar or keloids on the surgical site. No other adverse events, including post-inflammatory hyperpigmentation, scarring, or infection, were observed.

CONCLUSION

Adjuvant administration of PN along with conventional fractional laser treatment led to more favorable effect in wound healing and post-operative scar prevention after thyroidectomy. Lasers Surg. Med. © 2018 Wiley Periodicals, Inc.

Color Doppler Ultrasound Assessment of Activity in Keloids

BACKGROUND

The assessment of activity in keloids may be critical for defining their management. There is a lack of clinical scorings designed for the evaluation of keloids and biopsies may be contraindicated.

OBJECTIVE

To assess the sonographic activity of keloids in comparison with clinical scoring.

MATERIALS AND METHODS

A retrospective study of the clinical and color Doppler ultrasound (CDU) images of patients medically derived to CDU with the diagnosis of keloid was performed. Activity was evaluated clinically (modified Seattle Scar Scale) and CDU. Keloids were considered active when CDU detected vascularity within the lesion. Statistical analysis was performed (Wilcoxon-Mann-Whitney, Student t-test, and interobserver agreement).

RESULTS

Thirty-five patients with 42 keloids were evaluated. Color Doppler ultrasound provided the diameters, including depth, and vascularity. On CDU, 76% were active and 24% inactive. Clinically, Observer 1 found 55% and Observer 2 found 88% of active keloids. Interobserver agreement between clinical observers was moderate (k = 0.42). Subclinical fistulous tracts, involvement of the hypodermis, muscle, and calcifications were also found on CDU.

CONCLUSION

Color Doppler ultrasound can support the assessment of activity in keloids. Clinical evaluation alone can underestimate the activity in keloids. Relevant anatomical and subclinical features can be detected by CDU.