Early depth assessment of local burns by videomicroscopy: 24 h after injury is a critical time point

A systematic review on the quality of measurement techniques for the assessment of burn wound depth or healing potential

PURPOSE

Reliable and valid assessment of burn wound depth or healing potential is essential to treatment decision-making, to provide a prognosis, and to compare studies evaluating different treatment modalities. The aim of this review was to critically appraise, compare and summarize the quality of relevant measurement properties of techniques that aim to assess burn wound depth or healing potential.

METHODS

A systematic literature search was performed using PubMed, EMBASE and Cochrane Library. Two reviewers independently evaluated the methodological quality of included articles using an adapted version of the Consensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. A synthesis of evidence was performed to rate the measurement properties for each technique and to draw an overall conclusion on quality of the techniques.

RESULTS

Thirty-six articles were included, evaluating various techniques, classified as (1) laser Doppler techniques; (2) thermography or thermal imaging; (3) other measurement techniques. Strong evidence was found for adequate construct validity of laser Doppler imaging (LDI). Moderate evidence was found for adequate construct validity of thermography, videomicroscopy, and spatial frequency domain imaging (SFDI). Only two studies reported on the measurement property reliability. Furthermore, considerable variation was observed among comparator instruments.

CONCLUSIONS

Considering the evidence available, it appears that LDI is currently the most favorable technique; thereby assessing burn wound healing potential. Additional research is needed into thermography, videomicroscopy, and SFDI to evaluate their full potential. Future studies should focus on reliability and measurement error, and provide a precise description of which construct is aimed to measure.

Thermal injury of skin and subcutaneous tissues: A review of experimental approaches and numerical models

Thermal injury to skin and subcutaneous tissue is common in both civilian and combat scenarios. Understanding the change in tissue morphologies and properties and the underlying mechanisms of thermal injury are of vital importance to clinical determination of the degree of burn and treatment approach. This review aims at summarizing the research involving experimental and numerical studies of skin and subcutaneous tissue subjected to thermal injury. The review consists of two parts. The first part deals with experimental studies including burn protocols and prevailing imaging approaches. The second part deals with existing numerical models for burns of tissue and related computational simulations. Based on this review, we conclude that though there is literature contributing to the knowledge of the pathology and pathogenesis of tissue burn, there is scant quantitative information regarding changes in tissue properties including mechanical, thermal, electrical and optical properties as a result of burns that are linked to altered tissue morphology.

A systematic review of the evolution of laser Doppler techniques in burn depth assessment

Aims. The introduction of laser Doppler (LD) techniques to assess burn depth has revolutionized the treatment of burns of indeterminate depth. This paper will systematically review studies related to these two techniques and trace their evolution. At the same time we hope to highlight current controversies and areas where further research is necessary with regard to LD imaging (LDI) techniques. Methods. A systematic search for relevant literature was carried out on PubMed, Medline, EMBASE, and Google Scholar. Key search terms included the following: “Laser Doppler imaging,” “laser Doppler flow,” and “burn depth.” Results. A total of 53 studies were identified. Twenty-six studies which met the inclusion/exclusion criteria were included in the review. Conclusions. The numerous advantages of LDI over those of LD flowmetry have resulted in the former technique superseding the latter one. Despite the presence of alternative burn depth assessment techniques, LDI remains the most favoured. Various newer LDI machines with increasingly sophisticated methods of assessing burn depth have been introduced throughout the years. However, factors such as cost effectiveness, scanning of topographically inconsistent areas of the body, and skewing of results due to tattoos, peripheral vascular disease, and anaemia continue to be sighted as obstacles to LDI which require further research.

A new method of microskin autografting with a Vaseline-based moisture dressing on granulation tissue

In the conventional method of microskin autografting, aggressive early excision is adopted, followed by coverage with a microskin-allograft complex to close extensive burn wounds. However, early excision is always associated with a defect of viable tissue, resulting in massive blood loss and causing high risk to aged patients or those with other systemic diseases. We developed a new method in which an eschar thinning operation was first adopted, followed by raising granulation tissue and microskin autografting, which was covered by a Vaseline-based moisture dressing. A total of 52 patients were included in this study and randomly assigned to the control group (n=26) and the experimental group (n=26) for the conventional method and the new method, respectively. The re-epithelisation rate on the 21st day after autografting indicated that there was no significant difference between both groups. There was also no significant difference between the two groups when the re-epithelialisation rate was compared with the type of organisms cultured. However, the Vancouver Burn Skin Score (VBSS) results demonstrated a significant improvement of cosmetic appearance in the experimental group (score=2.1) as compared to the control group (score=3.9). The new method also showed other advantages, including less blood loss, shorter surgical duration and lower cost of surgery. From this prospective study, it can be concluded that the new method can be an alternative to the conventional microskin autografting procedure.

Early depth assessment of local burns by videomicroscopy: a novel proposed classification

PURPOSE

Videomicroscopy is very useful for burn depth assessment in an early phase; however, there is no practical classification that includes complicated anatomic, pathologic, and morphologic findings of burn wounds. The aim of this study was to propose a novel classification to assess burn depth in its early phase easily and reliably by videomicroscopy.

METHODS

Forty-four patients with 56 intermediate-depth burn wounds were included. Burn depth was divided into each grade according to our proposed classification, which is composed of five categories based on dermal capillary integrity patterns. The intrarater and interrater reliabilities of the assessment by the second and third authors were evaluated by Cohen's unweighted κ-value.

RESULTS

The results of the measurements according to the proposed classification showed an accuracy of 92.9%, sensitivity of 81.8%, and specificity of 100.0%. The intrarater reliability of the second and third authors showed substantial agreement (κ=0.719 and 0.729, respectively). The interrater reliability of the sum of each observer's variable also showed substantial agreement (κ=0.636).

CONCLUSION

This pattern analysis system is easy to use even for inexperienced personnel, and is reliable with high accuracy and specificity. Intrarater and interrater statistics also support its reliability and reproducibility.