Burn depth assessment using hyperspectral imaging in a prospective single center study

Hyperspectral Imaging Detects Clitoral Vascular Issues in Gender-Affirming Surgery

The aim of this study was to assess the efficacy of hyperspectral imaging (HSI) as an intraoperative perfusion imaging modality during gender affirmation surgery (GAS). The hypothesis posited that HSI could quantify perfusion to the clitoral complex, thereby enabling the prediction of either uneventful wound healing or the occurrence of necrosis. In this non-randomised prospective clinical study, we enrolled 30 patients who underwent GAS in the form of vaginoplasty with the preparation of a clitoral complex from 2020 to 2024 and compared patients' characteristics as well as HSI data regarding clitoris necrosis. Individuals demonstrating uneventful wound healing pertaining to the clitoral complex were designated as Group A. Patients with complete necrosis of the neo-clitoris were assigned to Group B. Patient characteristics were collected and subsequently a comparative analysis carried out. No significant difference in patient characteristics was observed between the two groups. Necrosis occurred when both StO2 and NIR PI parameters fell below 40%. For the simultaneous occurrence of StO2 and NIR PI of 40% or less, a sensitivity of 92% and specificity of 72% was calculated. Intraoperatively, the onset of necrosis in the clitoral complex can be reliably predicted with the assistance of HSI.

Consensus on the treatment of second-degree burn wounds (2024 edition)

Second-degree burns are the most common type of burn in clinical practice and hard to manage. Their treatment requires not only a consideration of the different outcomes that may arise from the dressing changes or surgical therapies themselves but also an evaluation of factors such as the burn site, patient age and burn area. Meanwhile, special attention should be given to the fact that there is no unified standard or specification for the diagnosis, classification, surgical procedure, and infection diagnosis and grading of second-degree burn wounds. This not only poses great challenges to the formulation of clinical treatment plans but also significantly affects the consistency of clinical studies. Moreover, currently, there are relatively few guidelines or expert consensus for the management of second-degree burn wounds, and no comprehensive and systematic guidelines or specifications for the treatment of second-degree burns have been formed. Therefore, we developed the Consensus on the Treatment of Second-Degree Burn Wounds (2024 edition), based on evidence-based medicine and expert opinion. This consensus provides specific recommendations on prehospital first aid, nonsurgical treatment, surgical treatment and infection treatment for second-degree burns. The current consensus generated a total of 58 recommendations, aiming to form a standardized clinical treatment plan.

Non-invasive medical imaging technology for the diagnosis of burn depth

Currently, the clinical diagnosis of burn depth primarily relies on physicians' judgements based on patients' symptoms and physical signs, particularly the morphological characteristics of the wound. This method highly depends on individual doctors' clinical experience, proving challenging for less experienced or primary care physicians, with results often varying from one practitioner to another. Therefore, scholars have been exploring an objective and quantitative auxiliary examination technique to enhance the accuracy and consistency of burn depth diagnosis. Non-invasive medical imaging technology, with its significant advantages in examining tissue surface morphology, blood flow in deep and changes in structure and composition, has become a hot topic in burn diagnostic technology research in recent years. This paper reviews various non-invasive medical imaging technologies that have shown potential in burn depth diagnosis. These technologies are summarized and synthesized in terms of imaging principles, current research status, advantages and limitations, aiming to provide a reference for clinical application or research for burn specialists.

Application of indocyanine green in surgery: A review of current evidence and implementation in trauma patients

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.

GL-FusionNet: Fusing global and local features to classify deep and superficial partial thickness burn

Burns constitute one of the most common injuries in the world, and they can be very painful for the patient. Especially in the judgment of superficial partial thickness burns and deep partial thickness burns, many inexperienced clinicians are easily confused. Therefore, in order to make burn depth classification automated as well as accurate, we have introduced the deep learning method. This methodology uses a U-Net to segment burn wounds. On this basis, a new thickness burn classification model that fuses global and local features (GL-FusionNet) is proposed. For the thickness burn classification model, we use a ResNet50 to extract local features, use a ResNet101 to extract global features, and finally implement the add method to perform feature fusion and obtain the deep partial or superficial partial thickness burn classification results. Burns images are collected clinically, and they are segmented and labeled by professional physicians. Among the segmentation methods, the U-Net used achieved a Dice score of 85.352 and IoU score of 83.916, which are the best results among all of the comparative experiments. In the classification model, different existing classification networks are mainly used, as well as a fusion strategy and feature extraction method that are adjusted to conduct experiments; the proposed fusion network model also achieved the best results. Our method yielded the following: accuracy of 93.523, recall of 93.67, precision of 93.51, and F1-score of 93.513. In addition, the proposed method can quickly complete the auxiliary diagnosis of the wound in the clinic, which can greatly improve the efficiency of the initial diagnosis of burns and the nursing care of clinical medical staff.

Burn characterization using object-oriented hyperspectral image classification

This paper presents a new approach based on hyperspectral imaging combined with an object-oriented classification method that allows the generation of burn depth classification maps facilitating easier characterization of burns. Hyperspectral images of 14 patients diagnosed with burns on the upper and lower limbs were acquired using a pushbroom hyperspectral imaging system. The images were analyzed using an object-oriented classification approach that uses objects with specific spectral, textural and spatial attributes as the minimum unit for classifying information. The method performance was evaluated in terms of overall accuracy, sensitivity, precision and specificity computed from the confusion matrix. The results revealed that the approach proposed in this study performed well in differentiating burn classes with a high level of overall accuracy (95.99% ± 0.60%), precision (97.30% ± 2.46%), sensitivity (97.23% ± 3.02%) and specificity (98.02% ± 1.98%). In conclusion, the object-based approach for burns hyperspectral images classification can provide maps that can help surgeons identify with better precision different depths of burn wounds.