Monitoring wound progression to healing in diabetic foot ulcers using three-dimensional wound imaging

Malone, Matthew; Schwarzer, Saskia; Walsh, Annie; Xuan, Wei; Gannass, Abdulaziz Al; Dickson, Hugh G; Bowling, Frank L.

doi:10.1016/j.jdiacomp.2019.107471

Cited by 13 publications

(16 citation statements)

References 22 publications

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“…4 Malone et al tested a further device against ruler-based measurements, and while area reliability was again excellent, volume reliability was moderate. 3 Area measurement, based on either method, was the best predictor of wound healing.…”

Section: Discussionmentioning

confidence: 95%

“…New technologies show promise in overcoming these issues. While recent studies have tested novel three-dimensional (3D) wound cameras for diabetes-related foot ulceration, 2-4 the use of these devices is technically complex and they are not yet widely accessible. Commercially available devices are increasingly utilized in wound care; however, reliability data specific to diabetes-related foot ulceration is lacking.…”

Section: Introductionmentioning

confidence: 99%

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Reliability of a Three-Dimensional Wound Camera and Correlation With Routine Ruler Measurement in Diabetes-Related Foot Ulceration

Lasschuit

Featherston

Tonks

2020

J Diabetes Sci Technol

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Background: In an era of increasing technology and telehealth utilization, three-dimensional (3D) wound cameras promise reliable, rapid, and touch-free ulceration measurements. However, reliability data for commercially available devices in the diabetes foot service setting is lacking. We aimed to evaluate the reliability of diabetes-related foot ulceration measurement using a 3D wound camera in comparison to the routinely used ruler and probe. Method: Participants were prospectively recruited from a tertiary interdisciplinary diabetes foot service. Ulcerations were measured at each visit by two blinded observers, first by ruler and probe, and then using a 3D wound camera twice. Reliability was evaluated using intraclass correlation coefficients (ICC). Measurement methods were compared by Pearson correlation. Results: Sixty-three ulcerations affecting 38 participants were measured over 122 visits. Interobserver reliability of ruler measurement was excellent for estimated area (ICC 0.98, 95% CI 0.97-0.98) and depth (ICC 0.93, 95% CI 0.90-0.95). Intraobserver and interobserver reliability of the 3D wound camera area was excellent (ICC 0.96, 95%CI 0.95-0.97 and 0.97 95% CI 0.96-0.98, respectively). Depth was unrecordable in over half of 3D wound camera measurements, and reliability was inferior to probe measurement. Area correlation between methods was good ( R = 0.88 and 0.94 per observer); however, depth correlation was poor ( R = 0.49 and 0.65). Conclusions: 3D wound cameras offer practical advantages over ruler-based measurement. In diabetes-related foot ulceration, the reliability and comparability of area measurement was excellent across both methods, although depth was more reliably obtained by the probe. These limitations, together with cost, are important considerations if implementing this technology in diabetes foot care.

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Reliability of a Three-Dimensional Wound Camera and Correlation With Routine Ruler Measurement in Diabetes-Related Foot Ulceration

Lasschuit

Featherston

Tonks

2020

J Diabetes Sci Technol

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“…Few histomorphology studies have validated newly-developed computer-based quantification methods with ICCs to compare the reliability of the methods with the evaluation done by a pathologist or a tissue specialist (e.g. surgeon), mostly considered as the gold standard method [8][9][10][11][12]. To the authors' knowledge, this study is the first to develop and validate a computerbased quantification method, with ICCs, to evaluate equine wound healing.…”

Section: Discussionmentioning

confidence: 99%

Development of a computer-based quantification method for immunohistochemically-stained tissues and its application to study mast cells in equine wound healing (proof of concept)

et al. 2020

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Background: There is a growing interest in the scientific community to use computer-based software programs for the quantification of cells during physiological and pathophysiological processes. Drawbacks of computer-based methods currently used to quantify immunohistochemical staining are the complexity of use, expense of software and overly-simplified descriptions of protocol thereby limiting reproducibility. The precise role of mast cells in equine cutaneous wound healing is unknown. Given the contribution of mast cells to the chronic inflammation observed in human keloid, a pathology similar to exuberant granulation tissue (EGT) in horses, mast cells might be present in high numbers in equine limb wounds predisposed to EGT. The main goal of this study was to develop a reliable and reproducible quantification method for immunostained tissues using a computer software that is widely available, at no cost, to the scientific community. A secondary goal was to conduct a proof of concept using the newly-established method to quantify mast cells during wound healing at different anatomical sites (body and limb) in horses to see if a different pattern is observed in limb wounds, which are predisposed to EGT. Results: A good intraclass correlation coefficient (ICC, 0.67 p < 0.05) was found between the computer-based ImageJ method and manual counting. An excellent intra-operator ICC of 0.90 (p < 0.01) was found for the ImageJ quantification method while a good interoperator ICC of 0.69 (p < 0.01) was measured. No significant difference was observed between the variation of the ImageJ and that of the manual counting method. Mast cells were localized below the epidermis, around cutaneous appendages and blood vessels. Mast cell numbers did not differ significantly in relation to anatomical location or time of healing. Conclusions: The computer-based quantification method developed is reliable, reproducible, available, cost-free and could be used to study different physiological and pathological processes using immunohistochemistry.

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“…In the patients whose ulcers healed completely, the processes of granulation, epithelialization, and Usefulness of high-frequency ultrasound to assess the healing progress of shin ulcers no available methods allowing one to make a precise and objective assessment of extensive wound healing. Usually photographic images are used to monitor this process; attempts are also being made to use 3D spatial models for assessment (12) . However, these methods do not make it possible to examine internal structures, i.e.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of high-frequency ultrasound to assess the healing progress of shin ulcers

2020

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Introduction: As the average lifespan becomes longer, the number of cases of chronic shin ulcers is rising, which is slowly becoming a societal problem. Currently, there no methods for objective evaluation of ulcer healing process. Aim of the study: The aim of the study was to assess the use of high-frequency ultrasound to monitor the healing of shin ulcers subjected to laser biostimulation. Material and methods: The study included 8 patients (4 men and 4 women) aged from 46 to 81 years with 9 shin ulcers in whom the healing process did not progress within 8 weeks despite effective causal treatment. The ulcers were subjected to laser biostimulation. The induced changes were monitored using high-frequency ultrasound and photographic records. Ultrasound examination was used to assess the depth of ulceration and the thickness of granulation tissue, migrating epidermis, subepidermal low-echogenic band (SLEB) and epidermis in the immediate vicinity. The wound severity index and ulcer vascularity were also assessed. Results: As a result of laser therapy, in 7 out of 9 cases the ulcers healed completely and in the remaining 2 cases ulcer size was reduced. During the ulcer healing process induced by laser therapy, ultrasound examination revealed decreasing ulcer depth, wound severity index and SLEB thickness. Granulation tissue increased in thickness and there was an epidermal formation effect (newly formed epidermis was much thicker than the one surrounding the wound and became thicker as a result of laser therapy sessions). During the healing of ulcers induced by laser therapy no significant changes were observed in ulcer vascularity and thickness of the surrounding epidermis. Conclusions: High-frequency ultrasound is a useful technique for the imaging of leg ulcers. It allows one to monitor their healing process induced by laser biostimulation. Further research on the subject needs to be pursued.

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Monitoring wound progression to healing in diabetic foot ulcers using three-dimensional wound imaging

Cited by 13 publications

References 22 publications

Reliability of a Three-Dimensional Wound Camera and Correlation With Routine Ruler Measurement in Diabetes-Related Foot Ulceration

Reliability of a Three-Dimensional Wound Camera and Correlation With Routine Ruler Measurement in Diabetes-Related Foot Ulceration

Development of a computer-based quantification method for immunohistochemically-stained tissues and its application to study mast cells in equine wound healing (proof of concept)

Usefulness of high-frequency ultrasound to assess the healing progress of shin ulcers

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