Wound Teleconsultation in Patients with Chronic Leg Ulcers

Abstract

Background: The treatment of chronic leg ulcers requires frequent assessments of local wound status and adjustment of therapy. The availability of reasonably priced photographic equipment and quick electronic transfer of high-quality digital images should make it possible that the assessment of wound status can be made by remote experts. Objective: This study examines the feasibility of using teledermatology for wound assessment and therapeutic suggestions for patients with chronic leg ulcers. Methods: One hundred ten chronic leg ulcers of different origins were examined in face-to-face consultations. The examining doctor assessed the wound, made therapeutic recommendations and took 1–4 photographs of the wound using a digital camera. The digital images and relevant clinical information were then transmitted via a web application to an expert in wound care, who provided an independent teledermatological assessment of wound status and therapeutic recommendations. Results: In our study, a high accordance between direct consultations and electronic consultations was found in the assessment of chronic leg ulcers, especially for important features like slough (concordance: 84.6%), necrosis (concordance: 98.2%) and granulation tissue formation (concordance: 76.4%). Furthermore, the teledermatologist generally felt confident in recommending further treatment strategies and in planning further wound assessments via the internet. Conclusions: Our results suggest that teledermatology offers great potential for the future in chronic wound care. By reducing the need to travel long distances to the hospital or to consult a physician with expertise in wound care, wound teleconsultation might lower health care costs and improve the quality of life for patients with chronic wounds, while still maintaining a high quality of wound care.

Úlceras crônicas dos membros inferiores: avaliação pela fotografia digital

“…A fotografia digital apresenta baixo custo, sendo disponível mesmo nas regiões mais carentes, entretanto sua principal vantagem reside na possibilidade de automatização, documentação e velocidade na mensuração, principalmente em um grande número de pacientes e embora o método planimétrico seja ainda mais barato, é mais trabalhoso, pode sofrer maiores interferências decorrentes do examinador e ser operacionalmente mais difícil de ser realizado 6 . O desenvolvimento de técnicas estimadoras da gravidade e da evolução do tratamento das UCMI pode permitir uma abrangência maior da assistência médica especializada, quer presencialmente ou a partir de teleconsultas, assim como pode contribuir junto à pesquisa médica sobre o tema 18,19 . Alguns autores consideram a fotografia como parte do prontuário médico e, no caso das UCMI, além da finalidade de pesquisa, as imagens podem fornecer subsídio às anotações do prontuário ou do registro eletrônico e documentar a evolução clínica em diferentes momentos 20,21 .…”

Teledermatology—A Hitherto Underestimated Tool in Occupational Medicine—Indications and Limitations

“…Therefore, teledermatology did not develop until the 1990s 4) , but has been utilised in many fields of application since then. It can be applied to melanoma screenings [7][8][9][10] , in the surveillance of the long-term therapy of leg ulcers 11) , or in medical attendance in rural or remote areas 12,13) . There is ample proof that telecare and teledermatology is practicable and well accepted by patients [14][15][16][17] .…”

Effectiveness of Telemedicine for Distant Wound Care Advice towards Patient Outcomes: Systematic Review and Meta-Analysis

“…Johnson-Mekota, et al [64] Outcome: Patients' and providers' satisfaction 58 Chan, et al [65] Outcome: Using scoring scale 59 Hill, et al 2009 [66] Outcome: Comparing accuracy of assessment 60 Salmhofer, et al [67] Outcome: Comparing accuracy of assessment • Page 4 of 9 •…”