Three-dimensional ultrasound imaging of the pressure ulcer. A case report

Yabunaka, Koichi; Iizaka, Shinji; Nakagami, Gojiro; Fujioka, Masayuki; Sanada, Hiromi

doi:10.11152/mu.2013.2066.173.kya

Cited by 8 publications

(3 citation statements)

References 14 publications

(16 reference statements)

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“…Also, there is often an inability to differentially diagnose deep tissue injury with other pathologies such as skin tear, ecchymosis, hematoma, dermatological condition, incontinence-associated dermatitis, Kennedy terminal ulcer, ischemic tissue change, and venous engorgement (7,10,33). Several proof-of-principle studies showed that both imaging and biomarker approaches could play a role in early diagnosis of deep tissue injury, but to date, they have not been translated into a clinical setting (4,21,45,54,63,68,84,87,89,91,96,102,107). This may be due partly to the fact that the etiology of deep tissue injury is complex and still not fully understood (6,92).…”

Section: Introductionmentioning

confidence: 99%

An advanced magnetic resonance imaging perspective on the etiology of deep tissue injury

Nelissen

Traa

Boer

et al. 2018

Journal of Applied Physiology

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Early diagnosis of deep tissue injury remains problematic due to the complicated and multifactorial nature of damage induction and the many processes involved in damage development and recovery. In this paper, we present a comprehensive assessment of deep tissue injury development and remodeling in a rat model by multiparametric magnetic resonance imaging (MRI) and histopathology. The tibialis anterior muscle of rats was subjected to mechanical deformation for 2 h. Multiparametric in vivo MRI, consisting of T, T*, mean diffusivity (MD), and angiography measurements, was applied before, during, and directly after indentation as well as at several time points during a 14-day follow-up. MRI readouts were linked to histological analyses of the damaged tissue. The results showed dynamic change in various MRI parameters, reflecting the histopathological status of the tissue during damage induction and repair. Increased T corresponded with edema, muscle cell damage, and inflammation. T* was related to tissue perfusion, hemorrhage, and inflammation. MD increase and decrease was reported on the tissue's microstructural integrity and reflected muscle degeneration and edema as well as fibrosis. Angiography provided information on blockage of blood flow during deformation. Our results indicate that the effects of a single damage-causing event of only 2 h of deformation were present up to 14 days. The initial tissue response to deformation, as observed by MRI, starts at the edge of the indentation. The quantitative MRI readouts provided distinct and complementary information on the extent, temporal evolution, and microstructural basis of deep tissue injury-related muscle damage. NEW & NOTEWORTHY We have applied a multiparametric MRI approach linked to histopathology to characterize damage development and remodeling in a rat model of deep tissue injury. Our approach provided several relevant insights in deep tissue injury. Response to damage, as observed by MRI, started at some distance from the deformation. Damage after a single indentation period persisted up to 14 days. The MRI parameters provided distinct and complementary information on the microstructural basis of the damage.

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Section: Introductionmentioning

confidence: 99%

An advanced magnetic resonance imaging perspective on the etiology of deep tissue injury

Nelissen

Traa

Boer

et al. 2018

Journal of Applied Physiology

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“…A recent small case series reported that US, Doppler and elastography could be used to determine wound morphology, biomechanics and proximity to other anatomical structures such as bone and tendon ( Henshaw et al 2020 ). Another case study of a 46-y-old woman with a stage IV sacral pressure ulcer revealed that multiple 2-D US images could be reconstructed for 3-D visualization of the ulcer ( Yabunaka et al 2015 ). Photoacoustic imaging and high-resolution harmonic US have also been used to stage and track healing of pressure ulcers and burn wounds in animal models ( Gnyawali et al 2015 ; Hariri et al 2019 ).…”

Section: Introductionmentioning

confidence: 99%

Point-of-Care Ultrasound as a Tool to Assess Wound Size and Tissue Regeneration after Skin Grafting

Mantri

Tsujimoto

Penny

et al. 2021

Ultrasound in Medicine & Biology

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Chronic wounds can be difficult to heal and are often accompanied by pain and discomfort. Multiple skin substitutes or cellularized/tissue-based skin products have been used in an attempt to facilitate closure of complex wounds. Allografts from cadaveric sources have been a viable option in achieving such closure. However, early assessment of graft incorporation has been difficult clinically, often with delayed evidence of failure. Visual cues to assess graft integrity have been limited and remain largely superficial at the skin surface. Furthermore, currently used optical imaging techniques can penetrate only a few millimeters deep into tissue. Ultrasound (US) imaging offers a potential solution to address this limitation. This work evaluates the use of US to monitor wound healing and allograft integration. We used a commercially available dual-mode (US and photoacoustic) scanner operating only in US mode. We compared the reported wound size from the clinic with the size measured using US in 45 patients. Two patients from this cohort received an allogenic skin graft and underwent multiple US scans over a 110-d period. All data were processed by two independent analysts; one of them was blinded to the study. We measured change in US intensity and wound contraction as a function of time. Our results revealed a strong correlation (R 2 = 0.81, p < 0.0001) between clinically and US-measured wound sizes. Wound contraction >91% was seen in both patients after skin grafting. An inverse relationship between wound size and US intensity (R 2 = 0.77, p < 0 .0001) indicated that the echogenicity of the wound bed increases as healthy cells infiltrate the allograft matrix, regenerating and leading to healthy tissue and re-epithelization. This work indicates that US can be used to measure wound size and visualize tissue regeneration during the healing process.

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“…Researchers have proposed some techniques to assess PU and understanding the role of ischemia on tissue damage which include Skin Blood Flow Measurement [10,[15][16][17] Ultra-sonography [5,[18][19][20], bioimpedance spectrometer [20][21] and histopathology study [22]. Skin blood flow measurement using Laser Doppler Flowmetry (LDF) is considered as the best reliable non-invasive method for the PU assessment because of its ability at revealing and determining the adjustment in skin blood flow in reaction to stimulus.…”

Section: Introductionmentioning

confidence: 99%

Wavelet transform based features of skin blood flow response signal for pressure ulcer evaluation

Ramli

Kamil

Ahmad

et al. 2020

JMES

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Pressure Ulcers (PUs) are localized tissue damage that usually occur over the soft tissue of body prominence when a subject is exposed to prolonged external mechanical loading. Several studies have proposed that skin blood flow response (SBFR) can be used in PU evaluation to determine tissue ischemic accumulation due to insufficient time of tissue recovery. In previous study, twenty one Sprague Dawley rats weigh 388-481g that were divided into three different group have been used to investigate the trends of SBFR signal using time domain features like peak reactive hyperaemia (RH), time to peak RH and area under the RH curve as well as frequency domain features like peak power spectral density (PSD) and total PSD. However, the results indicate that both frequency domain features are not effective at determining individual insufficient recovery time. In this study, Continuous Wavelet Transform (CWT) based features such as average amplitude and relative amplitude based on Morlet wavelet function scale 200 are investigated. The results show that the samples representing inconsistent trend of average amplitude for metabolic frequency range are dominant in all short (3 samples) , moderate (4 samples) and prolonged groups (4 samples), while no clear pattern can be established for relative amplitude. Hence both features may not suitable at distinguishing between sufficient and insufficient recovery time due to the low percentage in number of samples.

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Three-dimensional ultrasound imaging of the pressure ulcer. A case report

Cited by 8 publications

References 14 publications

An advanced magnetic resonance imaging perspective on the etiology of deep tissue injury

An advanced magnetic resonance imaging perspective on the etiology of deep tissue injury

Point-of-Care Ultrasound as a Tool to Assess Wound Size and Tissue Regeneration after Skin Grafting

Wavelet transform based features of skin blood flow response signal for pressure ulcer evaluation

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