1
|
Furferi R, Governi L, Pinzauti E, Profili A, Puggelli L, Volpe Y. A computational method for the investigation of burn scars topology based on 3D optical scan. Comput Biol Med 2022; 149:105945. [PMID: 35994934 DOI: 10.1016/j.compbiomed.2022.105945] [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: 05/04/2022] [Revised: 07/08/2022] [Accepted: 08/06/2022] [Indexed: 11/17/2022]
Abstract
Burn scar treatment is a difficult subject to address since the improper therapy can have a significant impact on people's quality of life. The evaluation of medical therapy over time should be based on objective measurement of the severity of burn scars and their progression. Unfortunately, most clinical assessments of scars are still reliant on physicians' subjective exams of patients. A profitable method to overcome the limitations of subjective assessment could be to leverage 3D scanning technologies. These could be used to retrieve the surface topology of burns. Accordingly, the goal of this study is to provide an objective approach for analysing the surface topology of burn scars using 3D scanning and roughness-based evaluation. In particular, two types of ISO-compliant profile and surface filters (Gaussian and Wavelet) derived from the analysis of roughness in the mechanical sector are implemented to discriminate form from roughness of scars. Once retrieved, the roughness surface is processed to derive a set of statistical parameters describing the scar surface topology. Three case studies were used to derive these parameters (a synthetic surface, an ostrich-skin surface and a set of scars). After the surface's roughness was determined, a comparison between healthy and unhealthy skin could be established. The devised methods prove their effectiveness in correctly retrieving the main surface characteristics of a burn scar. Therefore, by using the proposed method it will be possible to evaluate the effectiveness of medical therapy by comparing the healthy and scarred skin of a single subject.
Collapse
Affiliation(s)
- Rocco Furferi
- Department of Industrial Engineering, University of Florence, Italy.
| | - Lapo Governi
- Department of Industrial Engineering, University of Florence, Italy
| | | | - Andrea Profili
- Department of Industrial Engineering, University of Florence, Italy
| | - Luca Puggelli
- Department of Industrial Engineering, University of Florence, Italy
| | - Yary Volpe
- Department of Industrial Engineering, University of Florence, Italy
| |
Collapse
|
2
|
da Costa PTL, Echevarría-Guanilo ME, Gonçalves N, Girondi JBR, Gonçalves ADC. Subjective Tools for Burn Scar Assessment: An Integrative Review. Adv Skin Wound Care 2021; 34:1-10. [PMID: 33979826 DOI: 10.1097/01.asw.0000749732.09228.a9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To review the clinical and scientific literature on the subjective ways of assessing burn scars and describe their main characteristics. DATA SOURCES The Latin American, Caribbean Health Sciences Literature, Nursing Database, PubMed, CINAHL, and Scopus and Web of Science databases were used to search for studies published between 2014 and 2018 using descriptors in Portuguese, Spanish, and English. STUDY SELECTION After establishing the research question and the location and definition of the studies, as well as accounting for differences among databases and application of filters based on inclusion and exclusion criteria, 886 references remained. DATA EXTRACTION Investigators reviewed the titles and abstracts of the sample and selected 188 relevant studies for full review. DATA SYNTHESIS Twenty-six subjective forms of assessment were found; most research concerned the Patient and Observer Scar Assessment Scale and the Vancouver Scar Scale. CONCLUSIONS The Patient and Observer Scar Assessment Scale and the Vancouver Scar Scale are the most common scales for assessing burn scars and have similar evaluation points such as vascularization, pliability, pigmentation, and height, which are the main parameters that contribute to the general assessment and severity of a scar. There is a need to improve instructions for application of the scales to facilitate better understanding and improve agreement among evaluators.
Collapse
Affiliation(s)
- Pollyana Thays Lameira da Costa
- At the Department of Nursing, Universidade Federal de Santa Catarina, Florianópolis, Brazil, Pollyana Thays Lameira da Costa, MSN, RN, is a Doctorate Student and Maria Elena Echevarría Guanilo, DNP, RN; Natália Gonçalves, PhD, RN; and Juliana Balbinot Reis Girondi, PhD, RN, are Professors. Adriana da Costa Gonçalves, PhD, is Professor of Physical Therapy, Centro Universitário Barão de Mauá de Ribeirão Preto, Brazil. Acknowledgment: This study was completed as part of a scholarship funded by the Higher Education Personnel Improvement Coordination (Coordenação Aperfeiçoamento Pessoal do Nível Superior). The authors have disclosed no other financial relationships related to this article. Submitted September 3, 2020; accepted in revised form November 5, 2020
| | | | | | | | | |
Collapse
|
3
|
Chello C, Nenna A, Chello M, Satriano UM, Cardetta F, Lusini M, Nappi F, Dianzani C. Statin treatment and hypertrophic scarring after cardiac surgery. Wound Repair Regen 2020; 29:129-133. [PMID: 33236817 DOI: 10.1111/wrr.12878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/03/2020] [Accepted: 10/13/2020] [Indexed: 12/26/2022]
Abstract
Wound healing process after surgical procedure plays a crucial role to prevent blood loss and infections. Hypertrophic scars might occur after surgery and are generally associated with an inflammatory burden. Cardiac surgery is intrinsically related to a strong systemic inflammatory state that might favor hypertrophic scarring. Besides lipid-lowering effects, statins are known for their pleiotropic and anti-inflammatory activity. The aim of this study was to investigate the impact of statins in the healing process after median sternotomy in patients undergoing cardiac surgery. All patients undergoing major cardiac surgery with median sternotomy and cardiopulmonary bypass, and subsequently evaluated in the outpatient clinic after discharge, were included in this study. A total of 930 Caucasian patients were retrospectively reviewed. At outpatient visit, 276 patients (29.7%) showed the formation of hypertrophic scars. Patients with hypertrophic scars tended to be younger (P = .001) and nonstatin users (P = .001). Logistic regression analysis confirmed the protective role of statins (odds ratio 0.39, 95% confidence interval 0.29-0.53, P = .001), after adjustment for age. A dose-dependent effect was confirmed, showing a more intensive protective effect for higher doses of statins. Statin use might be correlated with reduced hypertrophic scars after cardiac surgery through median sternotomy. A dose-dependent effect has been shown, and statin effect seems to be independent of age in a selected population undergoing surgery with an elevated inflammatory burden. Although further studies are warranted to elucidate the biologic mechanisms, the concept of using statins as anti-scarring agents is novel and should be investigated with tailored studies.
Collapse
Affiliation(s)
- Camilla Chello
- Department of Dermatology, Università La Sapienza di Roma, Rome, Italy
| | - Antonio Nenna
- Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Massimo Chello
- Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | | | - Francesco Cardetta
- Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Mario Lusini
- Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint Denis, Paris, France
| | - Caterina Dianzani
- Department of Reconstructive Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| |
Collapse
|
4
|
Li G, Qin S, Sun X, Wang J, Zhang Y, Zhang J, Zhang J, Tang SC, Ren H. Retrospective observational cohort study on cosmetic outcome of using Ti-Ni memory alloy wire for intradermal suture following mastectomy in patients with breast cancer. Oncol Lett 2018; 15:2465-2470. [PMID: 29434959 DOI: 10.3892/ol.2017.7603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 10/03/2017] [Indexed: 12/23/2022] Open
Abstract
The method of suturing for incisions is crucial for the comprehensive treatment of clinical patients with breast cancer. Suturing is considered a major part of post-surgical recovery and may serve as a marker for evaluation of surgical outcome. The present study aimed to establish an effective means of suturing for patients who received modified radical surgery that helps to improve the cosmetic outcome of the incision. Enrolled patients were divided into an active and a control group. Ti-Ni memory alloy wire for intradermal suture in the active group and silk for interruption suture in the control group were applied to assess the different prognosis-associated factors. The Vancouver Scar Scale (VSS) was used to evaluate the wound size and the recovery time of the scars. The association between diabetes and the number of days of wound healing was also analyzed. The results indicated that the mean VSS score of the active group was decreased compared with that of the control group (P<0.001). The VSS scores of four main features (vascularity, pigmentation, pliability and height) between the two groups also statistically differed (P<0.001). Furthermore, the mean number of days of wound healing was significantly decreased for the active group compared with that for the control group (P=0.0026) in the patients with diabetes. In addition, the usage of Ti-Ni memory alloy wire was able to decrease the mean number of wound healing days between patients with diabetes and their non-diabetic counterparts (P=0.7009). The present study indicated that intradermal suture offers improved cosmetic outcome for patients undergoing mastectomy with or without axillary surgery. This technique may be useful for preventing scar overgrowth and for facilitating the recovery process in patients with diabetes.
Collapse
Affiliation(s)
- Gang Li
- Department of Thoracic Surgery and Oncology, Cancer Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xian, Shaanxi 710061, P.R. China
| | - Sida Qin
- Department of Thoracic Surgery and Oncology, Cancer Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xian, Shaanxi 710061, P.R. China
| | - Xin Sun
- Department of Thoracic Surgery and Oncology, Cancer Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xian, Shaanxi 710061, P.R. China
| | - Jiansheng Wang
- Department of Thoracic Surgery and Oncology, Cancer Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xian, Shaanxi 710061, P.R. China
| | - Yunfeng Zhang
- Department of Thoracic Surgery and Oncology, Cancer Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xian, Shaanxi 710061, P.R. China
| | - Jia Zhang
- Department of Thoracic Surgery and Oncology, Cancer Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xian, Shaanxi 710061, P.R. China
| | - Jing Zhang
- Department of Thoracic Surgery and Oncology, Cancer Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xian, Shaanxi 710061, P.R. China
| | - Shou-Ching Tang
- Division of Hematology and Oncology, The Georgia Cancer Center, Augusta University, Augusta, GA 30912, USA.,Tianjin Medical University Cancer Institute and Hospital, Tianjin 300070, P.R. China
| | - Hong Ren
- Department of Thoracic Surgery and Oncology, Cancer Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xian, Shaanxi 710061, P.R. China
| |
Collapse
|
5
|
Casanova D, Alliez A, Baptista C, Gonelli D, Lemdjadi Z, Bohbot S. A 1-Year Follow-Up of Post-operative Scars After the Use of a 1210-nm Laser-Assisted Skin Healing (LASH) Technology: A Randomized Controlled Trial. Aesthetic Plast Surg 2017; 41:938-948. [PMID: 28233128 DOI: 10.1007/s00266-017-0820-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 02/06/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Laser therapies are used prophylactically for excessive scar formation. The Laser-Assisted Skin Healing treatment induces a controlled heat stress that promotes tissue regeneration. This comparative trial is the first to evaluate the performance of a new automated 1210-nm laser system, compatible with all Fitzpatrick scale phototypes. METHODS Forty women undergoing bilateral breast reduction were enrolled in this double-blinded randomized controlled trial. The horizontal sutured incision of one breast was treated with the portable 1210-nm laser while in the operating theatre. The other breast was used as the study control. Objective measurements, subjective clinical assessments and safety evaluation were carried out over 1 year by both clinicians and patients. RESULTS Six weeks following surgery, better overall appearance and modified OSAS scores were reported for the laser-treated scars when compared to the control group (p = 0.024 and p = 0.079). This supports an early effect of the laser treatment during the inflammatory stage of the healing process. After a post-treatment period of 6 months, there continued to be a strong tendency in favour of the laser treatment based on the subjective scores and corroborated by the objective improvement of the treated scar volume (p = 0.038). At 1 year, the laser-treated scars continued to improve compared to the control ones in terms of volume (p = 0.004), surface (p = 0.017) and roughness (p = 0.002), and these comparatively better results were strengthened with the blind expression of patients' preference for their laser-treated scar (p = 0.025). CONCLUSIONS This new 1210-nm laser treatment, used as a single session performed immediately after surgery, provides significant objective and subjective improvements in scar appearance. These data can be useful when preparing patients to undergo their surgical procedure. LEVEL OF EVIDENCE I This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
|
6
|
Finlay V, Burrows S, Burmaz M, Yawary H, Lee J, Edgar DW, Wood FM. Increased burn healing time is associated with higher Vancouver Scar Scale score. Scars Burn Heal 2017; 3:2059513117696324. [PMID: 29799543 PMCID: PMC5965328 DOI: 10.1177/2059513117696324] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Increased burn wound healing time has been shown to influence abnormal scarring. This study hypothesised that scar severity increases commensurate to the increase in time to healing (TTH) of the wound. Wound healing and scar data from burn patients treated by the Burn Service of Western Australia at Royal Perth Hospital were examined. The relationship between TTH and scar severity, as assessed by the modified Vancouver Scar Scale (mVSS), was modelled using regression analysis. Interaction terms evaluated the effect of surgery and total body surface area - burn (TBSA) on the main relationship. Maximum likelihood estimation was used to account for potential bias from missing independent variable data. The sample had a median age of 34 years, TTH of 24 days, TBSA of 3% and length of stay of five days, 70% were men and 71% had burn surgery. For each additional day of TTH, the mVSS score increased by 0.11 points (P ≤ 0.001) per day in the first 21 days and 0.02 points per day thereafter (P = 0.004). The relationship remained stable in spite of TBSA or surgical intervention. Investigation of the effect of missing data revealed the primary model underestimated the strength of the association. An increase in TTH within 21 days of injury is associated with an increase in mVSS or reduced scar quality. The results confirm that efforts should be directed toward healing burn wounds as early as possible.
Collapse
Affiliation(s)
- Vidya Finlay
- State Adult Burn Service of Western
Australia, Fiona Stanley Hospital, Perth, WA, Australia
- Fiona Wood Foundation, Perth, WA,
Australia
- University of Western Australia, Perth,
WA, Australia
| | - Sally Burrows
- University of Western Australia, Perth,
WA, Australia
| | | | - Hussna Yawary
- University of Western Australia, Perth,
WA, Australia
| | - Johanna Lee
- University of Western Australia, Perth,
WA, Australia
| | - Dale W. Edgar
- State Adult Burn Service of Western
Australia, Fiona Stanley Hospital, Perth, WA, Australia
- Fiona Wood Foundation, Perth, WA,
Australia
- University of Notre Dame Australia,
Fremantle, WA, Australia
| | - Fiona M. Wood
- State Adult Burn Service of Western
Australia, Fiona Stanley Hospital, Perth, WA, Australia
- Fiona Wood Foundation, Perth, WA,
Australia
- University of Western Australia, Perth,
WA, Australia
| |
Collapse
|
7
|
Lee KC, Dretzke J, Grover L, Logan A, Moiemen N. A systematic review of objective burn scar measurements. BURNS & TRAUMA 2016; 4:14. [PMID: 27574684 PMCID: PMC4964074 DOI: 10.1186/s41038-016-0036-x] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 03/29/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND Problematic scarring remains a challenging aspect to address in the treatment of burns and can significantly affect the quality of life of the burn survivor. At present, there are few treatments available in the clinic to control adverse scarring, but experimental pharmacological anti-scarring strategies are now beginning to emerge. Their comparative success must be based on objective measurements of scarring, yet currently the clinical assessment of scars is not carried out systematically and is mostly based on subjective review of patients. However, several techniques and devices are being introduced that allow objective analysis of the burn scar. The aim of this article is to evaluate various objective measurement tools currently available and recommend a useful panel that is suitable for use in clinical trials of anti-scarring therapies. METHODS A systematic literature search was done using the Web of Science, PubMed and Cochrane databases. The identified devices were then classified and grouped according to the parameters they measured. The tools were then compared and assessed in terms of inter- and intra-rater reproducibility, ease of use and cost. RESULTS After duplicates were removed, 5062 articles were obtained in the search. After further screening, 157 articles which utilised objective burn scar measurement systems or tools were obtained. The scar measurement devices can be broadly classified into those measuring colour, metric variables, texture, biomechanical properties and pathophysiological disturbances. CONCLUSIONS Objective scar measurement tools allow the accurate and reproducible evaluation of scars, which is important for both clinical and scientific use. However, studies to evaluate their relative performance and merits of these tools are scarce, and there remain factors, such as itch and pain, which cannot be measured objectively. On reviewing the available evidence, a panel of devices for objective scar measurement is recommended consisting of the 3D cameras (Eykona/Lifeviz/Vectra H1) for surface area and volume, DSM II colorimeter for colour, Dermascan high-frequency ultrasound for scar thickness and Cutometer for skin elasticity and pliability.
Collapse
Affiliation(s)
- Kwang Chear Lee
- The Healing Foundation Burn Research Centre, University Hospital Birmingham Foundation Trust, Birmingham, B15 2TH UK
- School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - Janine Dretzke
- Public Health, Epidemiology and Biostatistics, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - Liam Grover
- School of Chemical Engineering, University of Birmingham, Birmingham, B15 2TT UK
| | - Ann Logan
- School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - Naiem Moiemen
- The Healing Foundation Burn Research Centre, University Hospital Birmingham Foundation Trust, Birmingham, B15 2TH UK
| |
Collapse
|
8
|
Wei Y, Li-Tsang CW, Luk DC, Tan T, Zhang W, Chiu TW. A validation study of scar vascularity and pigmentation assessment using dermoscopy. Burns 2015; 41:1717-1723. [DOI: 10.1016/j.burns.2015.05.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 05/13/2015] [Accepted: 05/14/2015] [Indexed: 10/23/2022]
|
9
|
Hermanns-Lê T, Piérard GE, Jennes S, Piérard-Franchimont C. Protomyofibroblast Pathway in Early Thermal Burn Healing. Skin Pharmacol Physiol 2015; 28:250-4. [PMID: 25998853 DOI: 10.1159/000430102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 04/07/2015] [Indexed: 11/19/2022]
Abstract
Wound healing following partial thickness thermal burns is commonly hampered by the risk of hypertrophic scarring. Skin myofibroblast (MF) density is commonly increased in postburn healing. The transition between fibroblast-like cells and α-smooth muscle actin (SMA)+ MF possibly begins with CD14+ monocytes, evolving to CD14+ CD34+ fibrocytes, followed by β-SMA+ protomyofibroblast (PMF) maturation. Skin biopsies from 25 burn patients were collected about 1 and 4 weeks after injury. Immunohistochemistry was performed using monoclonal antibodies to α-SMA, β-SMA, factor XIIIa, lysozyme, Mac 387, CD14, CD117 and Ulex europaeus agglutinin-1 (UEA-1). The set of Mac 387+ and CD14+ monocytes was accompanied by both CD34+ fibrocytes and factor XIIIa+ dendrocytes. By contrast, β-SMA+ PMF were rare. Of note, α-SMA+ MF were more abundant at week 4 than at week 1 (p < 0.01). The UEA-1+ endothelial cells showed marked variations in their dermal distribution, irrespective of the densities in the other scrutinized cells. In conclusion, healing of partial thickness thermal burns involves a diversity of cell types including PMF. In the present samples, the PMF density remained low. © 2015 S. Karger AG, Basel.
Collapse
Affiliation(s)
- Trinh Hermanns-Lê
- Department of Dermatopathology, University Hospital of Liège, Liège, Belgium
| | | | | | | |
Collapse
|
10
|
Continuous absorbable intradermal sutures yield better cosmetic results than nonabsorbable interrupted sutures in open appendectomy wounds: a prospective, randomized trial. World J Surg 2014; 38:1044-50. [PMID: 24318410 DOI: 10.1007/s00268-013-2396-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Acute appendicitis is the most common reason for abdominal surgery in young adults and children. Open appendectomy is still the treatment often chosen because it is simple, safe, and effective. Our aim was to study whether cosmetic results of appendectomy wounds are better after using continuous absorbable intradermal (A) sutures compared with wound closure with interrupted nonabsorbable (NA) sutures. METHODS A total of 206 adult patients with clinically suspected appendicitis were allocated to the study and prospectively randomized into two wound-closure groups: the interrupted NA suture group and the A suture group. Of these, 193 patients with sufficient data were invited to the outpatient clinic for cosmetic analysis. Cosmetic results were evaluated after a median of 14 months. For subjective scar assessment, the Vancouver scar scale, the patient and observer scar assessment scale (POSAS), and a visual analog scale (VAS) were used. Objective evaluation was carried out by measuring surface area, average width, and estimated concentration change (ECC) of hemoglobin and melanin in the scar using spectrocutometry. For statistical analyses we used the Mann-Whitney test and Student's t test. RESULTS Both objective and subjective analyses showed better cosmetic results for absorbable intradermal suturing. The difference between the two groups was statistically significant as regards POSAS in both patient (p = 0.032) and observer scales (p = 0.001), and VAS (p = 0.002). Scar surface area was significantly smaller in group A than in group NA (p = 0.002). ECC measurements showed higher values for melanin in group NA than in group A (p = 0.034). CONCLUSION Continuous intradermal absorbable suturing yields a better cosmetic result than interrupted nonabsorbable suturing in lower abdominal transverse appendectomy.
Collapse
|
11
|
Ghassemi P, Travis TE, Moffatt LT, Shupp JW, Ramella-Roman JC. A polarized multispectral imaging system for quantitative assessment of hypertrophic scars. BIOMEDICAL OPTICS EXPRESS 2014; 5:3337-54. [PMID: 25360354 PMCID: PMC4206306 DOI: 10.1364/boe.5.003337] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 08/26/2014] [Accepted: 08/27/2014] [Indexed: 05/20/2023]
Abstract
Hypertrophic scars (HTS) are a pathologic reaction of the skin and soft tissue to burn or other traumatic injury. Scar tissue can cause patients serious functional and cosmetic issues. Scar management strategies, specifically scar assessment techniques, are vital to improve clinical outcome. To date, no entirely objective method for scar assessment has been embraced by the medical community. In this study, we introduce for the first time, a novel polarized multispectral imaging system combining out-of-plane Stokes polarimetry and Spatial Frequency Domain Imaging (SFDI). This imaging system enables us to assess the pathophysiology (hemoglobin, blood oxygenation, water, and melanin) and structural features (cellularity and roughness) of HTS. To apply the proposed technique in an in vivo experiment, dermal wounds were created in a porcine model and allowed to form into scars. The developed scars were then measured at various time points using the imaging system. Results showed a good agreement with clinical Vancouver Scar Scale assessment and histological examinations.
Collapse
Affiliation(s)
- Pejhman Ghassemi
- Department of Electrical Engineering, The Catholic University of America, 620 Michigan Avenue, NE, Washington, DC 20064, USA
- Medstar Health Research Institute, MedStar Washington Hospital Center, 108 Irving Street, NW, Washington, DC 20010, USA
| | - Taryn E. Travis
- Medstar Health Research Institute, MedStar Washington Hospital Center, 108 Irving Street, NW, Washington, DC 20010, USA
| | - Lauren T. Moffatt
- Medstar Health Research Institute, MedStar Washington Hospital Center, 108 Irving Street, NW, Washington, DC 20010, USA
| | - Jeffrey W. Shupp
- Medstar Health Research Institute, MedStar Washington Hospital Center, 108 Irving Street, NW, Washington, DC 20010, USA
- Department of Biomedical Engineering, The Catholic University of America, 620 Michigan Avenue, NE, Washington, DC 20064, USA
| | - Jessica C. Ramella-Roman
- Department of Biomedical Engineering, The Catholic University of America, 620 Michigan Avenue, NE, Washington, DC 20064, USA
- Department of Biomedical Engineering and Herbert Wertheim College of Medicine, Florida International University, 10555 W. Flagler Street, Miami, FL 33174, USA
| |
Collapse
|
12
|
Gankande TU, Duke JM, Danielsen PL, DeJong HM, Wood FM, Wallace HJ. Reliability of scar assessments performed with an integrated skin testing device - the DermaLab Combo(®). Burns 2014; 40:1521-9. [PMID: 24630817 DOI: 10.1016/j.burns.2014.01.025] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 01/13/2014] [Accepted: 01/31/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND The DermaLab Combo(®) is a device with potential to make objective measurements of key scar components - pigmentation, vascularity, pliability and thickness. This study assessed the inter-rater and test-retest reliability of these measurements. METHOD Three raters performed scar assessments on thirty patients with burn scars using the DermaLab Combo(®). Measurements of pigmentation, vascularity, pliability and thickness were made and intra-class correlation coefficients (ICC) were derived for inter-rater and test-retest reliability. RESULTS Inter-rater reliability was found to be "excellent" in the 'best' and 'worst' areas of the index scar and normal skin for pigmentation (ICC: 0.94-0.98) and thickness (ICC: 0.86-0.96). Test-retest reliability was also "excellent" for pigmentation (ICC: 0.87-0.89) and thickness (ICC: 0.92-0.97) in all areas. Vascularity showed "good" to "excellent" inter-rater reliability (ICC: 0.66-0.84) in all areas however test-retest reliability was "low" (ICC: 0.29-0.42). Test-retest reliability was "excellent" for pliability (ICC: 0.76-0.91). Technical limitations were encountered making measurements in some scars for thickness, and in particular, pliability. CONCLUSION The DermaLab Combo(®) measured pigmentation, thickness and pliability with "excellent" reliability. If future studies provide protocols to improve test-retest reliability of vascularity measurements and obtain pliability measurements more successfully, the DermaLab Combo(®) will be valuable device for scar assessment.
Collapse
Affiliation(s)
- T U Gankande
- Burn Injury Research Unit, School of Surgery, The University of Western Australia, Australia.
| | - J M Duke
- Burn Injury Research Unit, School of Surgery, The University of Western Australia, Australia
| | - P L Danielsen
- Burn Injury Research Unit, School of Surgery, The University of Western Australia, Australia; Department of Dermatology, Bispebjerg University Hospital, Denmark
| | - H M DeJong
- Burn Injury Research Unit, School of Surgery, The University of Western Australia, Australia; Burn Outcomes Centre, Royal Perth Hospital, Australia
| | - F M Wood
- Burn Injury Research Unit, School of Surgery, The University of Western Australia, Australia; Burn Outcomes Centre, Royal Perth Hospital, Australia
| | - H J Wallace
- Burn Injury Research Unit, School of Surgery, The University of Western Australia, Australia
| |
Collapse
|
13
|
Gankande TU, Wood FM, Edgar DW, Duke JM, DeJong HM, Henderson AE, Wallace HJ. A modified Vancouver Scar Scale linked with TBSA (mVSS-TBSA): Inter-rater reliability of an innovative burn scar assessment method. Burns 2013; 39:1142-9. [PMID: 23433706 DOI: 10.1016/j.burns.2013.01.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 01/19/2013] [Accepted: 01/28/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Current scar assessment methods do not capture variation in scar outcome across the burn scar surface area. A new method (mVSS-TBSA) using a modified Vancouver Scar Scale (mVSS) linked with %TBSA was devised and inter-rater reliability was assessed. METHOD Three raters performed scar assessments on thirty patients with burn scars using the mVSS-TBSA. Scoring on pigmentation, vascularity, pliability and height was undertaken for the 'best' and 'worst' areas of each scar. Raters allocated the total body surface area of the scar (%TBSA) to three mVSS categories (<5, 5-10, >10). Intra-class correlation coefficient (ICC) and weighted kappa statistic (kw) were used to assess inter-rater reliability. The data were also analysed for clinically relevant misclassifications between pairs of raters. RESULTS Total mVSS scores showed 'fair to good' agreement (ICC 0.65-0.73) in the 'best' area of the scar while there was 'excellent' agreement in the 'worst' scar area (ICC 0.85-0.88). The kw of the individual mVSS components ranged from 0.44 to 0.84 and 0.02 to 0.86 for 'best' and 'worst' scar areas, respectively. Determination of scar %TBSA had 'excellent' reliability (ICC 0.91-0.96). Allocation of scar %TBSA to severity category <5 mVSS demonstrated 'good to excellent' reliability (ICC 0.63-0.80) and 'fair to good' reliability (ICC 0.42-0.74) for 5-10 mVSS category. However, misclassifications were observed for the total mVSS score in the 'worst' scar area and the allocation of scar %TBSA in the <5 mVSS category. CONCLUSION Inter-rater reliability of mVSS scores depends on the severity of the scar area being assessed. The mVSS-TBSA method of allocation of scar %TBSA to two broad mVSS categories, namely <5 and ≥5 mVSS, has 'good to excellent' reliability. The mVSS-TBSA has demonstrated utility for both clinical and research purposes; however, there is potential to misclassify scar outcome in some cases.
Collapse
Affiliation(s)
- T U Gankande
- Burns Injury Research Unit, School of Surgery, The University of Western Australia, Australia.
| | | | | | | | | | | | | |
Collapse
|
14
|
Jones H. Clinimetrics of tristimulus colourimeters in scar assessment: a review of evidence. J Wound Care 2012; 21:30-5. [DOI: 10.12968/jowc.2012.21.1.30] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- H.G. Jones
- University Hospital of Wales, Cardiff, UK
| |
Collapse
|
15
|
Improved skin wound epithelialization by topical delivery of soluble factors from fibroblast aggregates. Burns 2011; 38:541-50. [PMID: 22113100 DOI: 10.1016/j.burns.2011.10.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 10/27/2011] [Accepted: 10/31/2011] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Timely coverage of an excised burn wound with a split-thickness skin graft, and efficient epithelialization at the donor site wound are key components in the treatment of burn patients. Prompt healing is dependent on paracrine support from underlying dermal connective tissue fibroblasts. STUDY AIM Using the skin graft donor site in pig as a model for epithelialization, our aim was to evaluate if dermal signals, derived from cultured dermal fibroblast aggregates (Finectra), can promote epidermal regeneration. MATERIALS AND METHODS Partial-thickness skin wounds were made with a dermatome on the backs of three domestic pigs. After randomization, topical treatment was initiated by application of Finectra (n=6) or factors from standard fibroblast monolayer cultures (n=6) trapped in a slow-clotting fibrin matrix. Saline was applied to contralateral wounds to serve as corresponding untreated controls (n=12). After 3 days, full-thickness skin samples representing the whole wound area were obtained. Histological sections of these samples were analyzed for epithelialization, cell migration from lateral wound edges and hair follicles, as well as for formation of granulation tissue. RESULTS In response to topical delivery of Finectra, a significant acceleration of epithelialization (p<0.001) across the wound surface as well as from the wound edges was evident. Marked increase in thickness of granulation tissue (p<0.001) was noted in wounds treated with Finectra. Epihelialization originated from adnexal structures in which epithelial islets showed positive staining for cytokeratin-14 and PCNA. CONCLUSION These data show that the fibroblast aggregate-derived paracrine mediators, Finectra, stimulate epidermal regeneration in vivo.
Collapse
|