Photographs Of Wounds Research Articles

Quality of life improvement in patients with hard-to-heal leg wounds treated with Prontosan wound irrigation solution and wound gel.

This study evaluated the impact of four weeks of treatment with Prontosan Wound Irrigation Solution and Prontosan Wound Gel (B. Braun Medical Inc., US) on adults with hard-to-heal leg wounds. Overall change (weeks 1-5) in the Global Quality of Life scale (GQOL), changes in body, psyche and everyday life (EDL) quality of life (QoL) subscores, and changes in wound appearance and size after treatment were assessed. In this prospective, open-label, single-arm, five-centre study, non-hospitalised patients with no more than two wounds below the knee were recruited into the study; wounds were ≥5cm2 and ≤50cm2 and present for ≥4 weeks. The investigator or a designee applied the wound solution and gel to the wounds at clinic visits, and patients/caregivers applied the wound solution and gel at home. Wound-QoL questionnaires were completed at the initial screening and at each week of treatment. Wound size and photographs were obtained at pre- and post-treatment during clinic visits. A total of 43 patients were enrolled in the study. Mean GQOL scores decreased by 1.11 (46.1%). Body, psyche and EDL decreased by 1.17 (60.0%), 1.26 (41.8%) and 1.00 (42.2%), respectively. Wounds also showed improvement in odour, appearance and size. Adverse events were mild in intensity and transient in nature. This study demonstrated marked improvement in the QoL of patients with hard-to-heal leg wounds below the knee during four weeks of treatment with the wound solution and gel. Wounds also showed improvement in odour, appearance and size, and the treatment solution and gel were well tolerated. B. Braun Medical Inc. funded the research and preparation of this article. AK, DV, CRC and WC are employees of B. Braun Medical Inc. AO and RS declare no conflict of interest.

Software-Based Method for Automated Segmentation and Measurement of Wounds on Photographs Using Mask R-CNN: a Validation Study.

In clinical routine, wound documentation is one of the most important contributing factors to treating patients with acute or chronic wounds. The wound documentation process is currently very time-consuming, often examiner-dependent, and therefore imprecise. This study aimed to validate a software-based method for automated segmentation and measurement of wounds on photographic images using the Mask R-CNN (Region-based Convolutional Neural Network). During the validation, five medical experts manually segmented an independent dataset with 35 wound photographs at two different points in time with an interval of 1month. Simultaneously, the dataset was automatically segmented using the Mask R-CNN. Afterwards, the segmentation results were compared, and intra- and inter-rater analyses performed. In the statistical evaluation, an analysis of variance (ANOVA) was carried out and dice coefficients werecalculated. The ANOVA showed no statistically significant differences throughout all raters and the network in the first segmentation round (F = 1.424 and p > 0.228) and the second segmentation round (F = 0.9969 and p > 0.411). The repeated measure analysis demonstrated no statistically significant differences in the segmentation quality of the medical experts over time (F = 6.05 and p > 0.09). However, a certain intra-rater variability was apparent, whereas the Mask R-CNN consistently provided identical segmentations regardless of the point in time. Using the software-based method for segmentation and measurement of wounds on photographs can accelerate the documentation process and improve the consistency of measured values while maintaining quality and precision.

5: 3D Transglutaminase Fibronectin Hydrogel Therapy Improves the Healing of Chronic Irradiated Porcine Skin Wounds

Purpose:Chronic irradiated wounds are characterized by a delayed and incomplete healing course. Currently, there are no therapies directed at the deficient or dysfunctional biology associated with cutaneous radiation injury. We have previously demonstrated that fibronectin is a key extracellular matrix glycoprotein known to be significantly downregulated in radiation-damaged skin. We further identified that an enzymatically crosslinked hydrogel is a suitable construct for incremental fibronectin release in vitro and in murine wound models. Our present objective was to investigate the design of this fibronectin hydrogel dressing for the treatment of irradiated wounds in the clinically relevant porcine irradiated wound model.Methods:We created a chronic irradiation skin injury model in female Yucatan minipigs. Two 1-month-old minipigs underwent irradiation of the right dorsolateral neck region for 5 consecutive days in 5.5 Gy fractionated doses for a total of 27.5 Gy. Following irradiation, the minipigs were allowed 6 weeks of recovery to enable chronic irradiation skin changes to develop. After recovery, nine 1 cm x 1 cm full-thickness wounds were created in the irradiated fields. After wound creation, 100 μl of fibronectin hydrogel was topically applied on experimental wounds and 100 μl of phosphate-buffered saline (PBS) hydrogel was applied on control wounds. Standardized wound photographs were taken at weekly time intervals to calculate the percentage of wound closure relative to original wound size. Tissues isolated from the wound areas were evaluated histologically for wound healing quality and analyzed for gene and protein levels of radiation injury mediators with quantitative RT-PCR and ELISA.Results:Wounds treated with fibronectin hydrogel demonstrated significantly faster wound closure and decreased scarring than wounds treated with PBS hydrogel. On postoperative day 21, the mean percentage of wound area relative to original wound size was significantly higher in the control wounds (21.3% ± 2.8%) than in the fibronectin-treated wounds (4.7 ± 1.0%). By the experimental endpoint on postoperative day 28, the mean percentage of control wound area was 6.8% ± 2.9% while all fibronectin-treated wounds were fully healed. Picrosirius red staining demonstrated that the fibronectin-treated wounds had decreased total scar area (9.9 ± 3.0 mm2) compared to control wounds (38.1 ± 3.6 mm2). In addition, fibronectin hydrogel treatment was associated with decreased levels of radiation-induced inflammatory mediators. RT-qPCR of samples from fibronectin-treated wounds had significantly lower mRNA levels of TGF-β1 (0.45 ± 0.09) compared to levels in control wounds (1 ± 0.13). Similarly, RT-qPCR data revealed that relative mRNA levels of SMAD3 were significantly lower in fibronectin-treated wounds (0.34 ± 0.11) than in control wounds (1 ± 0.43). Lastly, protein level correlation with ELISA identified significantly lower TGF-β1 concentrations in fibronectin-treated wounds (2682 + 515.83 pg/mL) compared to control wounds (5244.5 + 700.08 pg/mL).Conclusion:Hydrogel-facilitated delivery of fibronectin significantly improved the rate and quality of wound healing in a porcine chronic irradiation wound model. Thus, this novel mechanism of fibronectin supplementation demonstrates potential for treating these otherwise nonhealing wounds.

Use of Amniotic Tissue-Derived Allografts Post-Mohs Micrographic Surgery: A Preliminary Study Assessing Wound Closure Rate.

When closure is not feasible, Mohs micrographic surgical wounds typically are left to heal by secondary intention and require weeks to close. Amniotic tissue-derived allograft (ATDA) has proven successful in promoting wound closure in diabetic and refractory wounds, and it may be beneficial for patients who have undergone Mohs micrographic surgery. The authors conducted a preliminary study to assess the efficacy of ATDA in speeding wound closure time and improving cosmetic outcomes in the specified patient population. Patients received an injection of amniotic fluid, an overlay of amniotic membrane, or standard of care. Photographs of wounds taken at the time of treatment and at each subsequent visit were analyzed. The cosmetic outcome and time to wound closure appeared to be improved in patients treated with ATDA when compared with expected outcomes. Owing to small sample size, differences in initial defect size, and variety of body locations, the wound closure rate between treatment groups was not found to be significantly different with most comparisons. Statistical significance was seen, however, when normalized closure rates between membrane and control intervention were compared after outlier analysis (P = .0288). Data indicate that ATDA treatment may be beneficial and suggest that further investigation of the efficacy of ATDA to promote wound healing and improve cosmetic outcomes of post-Mohs surgical wounds is warranted. Future studies should be designed to match initial defect size and location between control and treatment groups.

Disability, pain, and wound-specific concerns self-reported by adults at risk of limb loss: A cross-sectional study using the World Health Organization Disability Assessment Schedule 2.0

There has been limited study of patient-reported outcomes (PROs) in patients at risk of limb loss. Our primary objective was to estimate the prevalence of disability in this patient population using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). We recruited patients referred to a limb-preservation clinic. Patients self-reported their disability status using the 12-domain WHODAS 2.0. Severity of disability in each domain was scored from 1 = none to 5 = extreme and the total normalized to a 100-point scale (total score ≥25 = clinically significant disability). We also asked patients about wound-specific concerns and wound-related discomfort or distress. We included 162 patients. Reasons for clinic referral included arterial-insufficient (37.4%), postoperative (25.9%), and mixed etiology (10.8%) wounds. The mean WHODAS 2.0 disability score was 35.0 (standard deviation = 16.0). One-hundred-and-nineteen (73.5%) patients had clinically significant disability. Patients reported they had the greatest difficulty walking a long distance (mean score = 4.2), standing for long periods of time (mean score = 3.6), taking care of household responsibilities (mean score = 2.7), and dealing with the emotional impact of their health problems (mean score = 2.5). In the two-weeks prior to presentation, 87 (52.7%) patients expressed concern over their wound(s) and 90 (55.6%) suffered a moderate amount or great deal of wound-related discomfort or distress. In adjusted ordinary least squares regression models, although WHODAS 2.0 disability scores varied with changes in wound volume (p = 0.03) and total revised photographic wound assessment tool scores (p<0.001), the largest decrease in disability severity was seen in patients with less wound-specific concerns and wound-related discomfort and distress. The majority of people at risk of limb loss report suffering a substantial burden of disability, pain, and wound-specific concerns. Research is needed to further evaluate the WHODAS 2.0 in a multicenter fashion among these patients and determine whether care and interventions may improve their PROs.

Skin substitutes with noncultured autologous skin cell suspension heal porcine full-thickness wounds in a one-stage procedure.

Clinical application of skin substitute is typically a two‐stage procedure with application of skin substitute matrix to the wound followed by engraftment of a split‐thickness skin graft (STSG). This two‐stage procedure requires multiple interventions, increasing the time until the wound is epithelialised. In this study, the feasibility of a one‐stage procedure by combining bioengineered collagen‐chondroitin‐6‐sulfate (DS1) or decellularised fetal bovine skin substitute (DS2) with autologous skin cell suspension (ASCS) in a porcine full‐thickness wound healing model was evaluated. Twelve full‐thickness excisional wounds on the backs of pigs received one of six different treatments: empty; ASCS; DS1 with or without ASCS; DS2 with or without ASCS. The ASCS was prepared using a point‐of‐care device and was seeded onto the bottom side of DS1, DS2, and empty wounds at 80 000 cells/cm2. Wound measurements and photographs were taken on days 0, 9, 14, 21, 28, 35, and 42 post‐wounding. Histological analysis was performed on samples obtained on days 9, 14, 28, and 42. Wounds in the empty group or with ASCS alone showed increased wound contraction, fibrosis, and myofibroblast density compared with other treatment groups. The addition of ASCS to DS1 or DS2 resulted in a marked increase in re‐epithelialisation of wounds at 14 days, from 15 ± 11% to 71 ± 20% (DS1 vs DS1 + ASCS) or 28 ± 14% to 77 ± 26 (DS2 vs DS2 + ASCS) despite different mechanisms of tissue regeneration employed by the DS used. These results suggest that this approach may be a viable one‐stage treatment in clinical practice.

Development of a Method for Clinical Evaluation of Artificial Intelligence–Based Digital Wound Assessment Tools

Accurate assessment of wound area and percentage of granulation tissue (PGT) are important for optimizing wound care and healing outcomes. Artificial intelligence (AI)-based wound assessment tools have the potential to improve the accuracy and consistency of wound area and PGT measurement, while improving efficiency of wound care workflows. To develop a quantitative and qualitative method to evaluate AI-based wound assessment tools compared with expert human assessments. This diagnostic study was performed across 2 independent wound centers using deidentified wound photographs collected for routine care (site 1, 110 photographs taken between May 1 and 31, 2018; site 2, 89 photographs taken between January 1 and December 31, 2019). Digital wound photographs of patients were selected chronologically from the electronic medical records from the general population of patients visiting the wound centers. For inclusion in the study, the complete wound edge and a ruler were required to be visible; circumferential ulcers were specifically excluded. Four wound specialists (2 per site) and an AI-based wound assessment service independently traced wound area and granulation tissue. The quantitative performance of AI tracings was evaluated by statistically comparing error measure distributions between test AI traces and reference human traces (AI vs human) with error distributions between independent traces by 2 humans (human vs human). Quantitative outcomes included statistically significant differences in error measures of false-negative area (FNA), false-positive area (FPA), and absolute relative error (ARE) between AI vs human and human vs human comparisons of wound area and granulation tissue tracings. Six masked attending physician reviewers (3 per site) viewed randomized area tracings for AI and human annotators and qualitatively assessed them. Qualitative outcomes included statistically significant difference in the absolute difference between AI-based PGT measurements and mean reviewer visual PGT estimates compared with PGT estimate variability measures (ie, range, standard deviation) across reviewers. A total of 199 photographs were selected for the study across both sites; mean (SD) patient age was 64 (18) years (range, 17-95 years) and 127 (63.8%) were women. The comparisons of AI vs human with human vs human for FPA and ARE were not statistically significant. AI vs human FNA was slightly elevated compared with human vs human FNA (median [IQR], 7.7% [2.7%-21.2%] vs 5.7% [1.6%-14.9%]; P < .001), indicating that AI traces tended to slightly underestimate the human reference wound boundaries compared with human test traces. Two of 6 reviewers had a statistically higher frequency in agreement that human tracings met the standard area definition, but overall agreement was moderate (352 yes responses of 583 total responses [60.4%] for AI and 793 yes responses of 1166 total responses [68.0%] for human tracings). AI PGT measurements fell in the typical range of variation in interreviewer visual PGT estimates; however, visual PGT estimates varied considerably (mean range, 34.8%; mean SD, 19.6%). This study provides a framework for evaluating AI-based digital wound assessment tools that can be extended to automated measurements of other wound features or adapted to evaluate other AI-based digital image diagnostic tools. As AI-based wound assessment tools become more common across wound care settings, it will be important to rigorously validate their performance in helping clinicians obtain accurate wound assessments to guide clinical care.

Smartphone photography for smart assessment of post-surgical wounds - an experience during the COVID-19 pandemic.

This study was undertaken with an aim to assess the feasibility of substitution of real-life clinical follow up with a review of smartphone captured digital photographs of post-surgical wounds by a clinician to assess wound healing. The postoperative patients who understood the objectives got enrolled in the prospective study and were followed up. They were requested to capture the digital photographs of the wounds with the smartphones and send through WhatsApp on postoperative days 3, 5, 7, 15 and 30 or else whenever they felt need for review due to symptoms like fever, pain, redness or swelling. 24 abdominal, 2 extremity and 1 neck wounds were followed up in 27 patients. 3 patients developed complications and all were detected with 100% accuracy. 81% of the patients were satisfied with this mode of postoperative wound assessment. The experience shows that, in the follow up of postsurgical wounds, there is good correlation between real life clinical and remote photographic review. Incorporating photographic wound assessment into a postoperative follow-up care pathway may potentially decrease the postoperative hospital visits and decrease burden on healthcare facilities.

Smartphone photography for smart assessment of post-surgical wounds - an experience during the COVID-19 pandemic.

&lt;br&gt;&lt;b&gt;Aim:&lt;/b&gt; This study was undertaken with an aim to assess the feasibility of monitoring of wound healing by replacement of the traditional real-life clinical follow-up with a review of smartphone-captured digital photographs of post-surgical wounds by a clinician.&lt;/br&gt; &lt;br&gt;&lt;b&gt;Method:&lt;/b&gt; The postoperative patients who understood the objectives got enrolled in the prospective study and were followed up. They were requested to capture digital photographs of the wounds using smartphones and send them through WhatsApp on postoperative days 3, 5, 7, 15 and 30 or else whenever they felt need for review due to symptoms like fever, pain, redness or swelling.&lt;/br&gt; &lt;br&gt;&lt;b&gt;Results:&lt;/b&gt; 24 abdominal, 2 extremity and 1 neck wounds were followed up in 27 patients. Three patients developed complications and all were detected with 100% accuracy. As many as 81% of the patients were satisfied with this mode of postoperative wound assessment.&lt;/br&gt; &lt;br&gt;&lt;b&gt;Conclusion:&lt;/b&gt; The experience shows that in the follow-up of postsurgical wounds, there is a good correlation between real-life clinical and remote photographic review. Incorporating photographic wound assessment into the postoperative follow-up care pathway can potentially decrease the number of postoperative hospital visits and decrease the burden on healthcare facilities.&lt;/br&gt.

Smartphone application for wound area measurement in clinical practice.

A total of 85 consecutive patients had their wound area measured. The procedure was executed in two parts. The first was to take photographs of the wound using a smartphone and measure the area using the imitoMeasure application (imito; imito AG, Zurich, Switzerland) by two raters. The second was to take photographs of the same wound using a 10-megapixel digital camera and posterior measurement of the area using ImageJ software (National Institutes of Health, Bethesda, Md) by one operator. The mean area of the wounds was 12.20 ± 10.45 cm2 for imito and 12.67 ± 10.86 cm2 for ImageJ measurement. The interclass correlation coefficient (ICC) between ImageJ and imito was 0.978 for a single measure and 0.989 for the average measure. Considering the two measurements, the ICC demonstrated excellent interobserver correlation using imito (0.987). Larger wounds had a greater difference between the methods (4.28% greater with the ImageJ measurement when considering areas >9 cm2). No difference was found between iOS (ICC, 0.995) and android (ICC, 0.970) smartphone operating systems. The smartphone application is a useful method for area measurement with excellent accuracy compared with digital photography and the ImageJ processing tool.

Reliability study of a new wound classification system for patients with diabetes

Introduction: Wound classification systems, specifically for diabetic ulcer patients, have been less explored in reliability studies than other types, such as pressure ulcers. Therefore, this study evaluates the inter-rater reliability of a new wound classification system developed for diabetic foot ulcers in Indonesia. Method: This is a cross-sectional pilot study carried out to determine the inter-rater reliability of the Suriadi, Haryanto, Imran dan Defa (SHID) wound classification system at the Kitamura Wound Clinic in Pontianak city, Indonesia. Fifteen adult outpatients with diabetic ulcers were asked to participate in the evaluation of the wound classification systems and forty wound photographs were used. Results: The result showed that the inter-rater reliability scores of the SHID were in perfect agreement (kappa [κ]=0.81- 1.00) as opposed to the Wagner (κ=0.43-0.77) and the Texas (κ=0.34-63) wound classification systems. Conclusion: The SHID wound classification system can help identify severe wounds for treatment, especially among people with diabetic ulcerss.

Comprehensive Assessment of Fine-Grained Wound Images Using a Patch-Based CNN With Context-Preserving Attention.

Goal: Chronic wounds affect 6.5 million Americans. Wound assessment via algorithmic analysis of smartphone images has emerged as a viable option for remote assessment. Methods: We comprehensively score wounds based on the clinically-validated Photographic Wound Assessment Tool (PWAT), which comprehensively assesses clinically important ranges of eight wound attributes: Size, Depth, Necrotic Tissue Type, Necrotic Tissue Amount, Granulation Tissue type, Granulation Tissue Amount, Edges, Periulcer Skin Viability. We proposed a DenseNet Convolutional Neural Network (CNN) framework with patch-based context-preserving attention to assess the 8 PWAT attributes of four wound types: diabetic ulcers, pressure ulcers, vascular ulcers and surgical wounds. Results: In an evaluation on our dataset of 1639 wound images, our model estimated all 8 PWAT sub-scores with classification accuracies and F1 scores of over 80%. Conclusions: Our work is the first intelligent system that autonomously grades wounds comprehensively based on criteria in the PWAT rubric, alleviating the significant burden that manual wound grading imposes on wound care nurses.

Effect of Hyaluronic Acid Cream in Management of Maxillofacial Wounds

The present study aims to determine the efficacy of hyaluronic acid cream in the management of maxillofacial wounds. Total of twenty-five patients who were randomly assigned to study group, was admitted in for trauma management with facial lacerations was administered hyaluronic acid cream 0.5% (BIONECT) for one week twice daily application on the wounds .the wounds were then assessed with PWAT (photographic wound assessment tool) at 3rd day, 5th day, 7th day respectively. The control group (n=25) was administered with povidone-iodine cream. The study group showed a statistically significant difference (p&lt;0.005) in wound healing earlier than the control group at 7th day. Patient compliance was higher in the study group than the control group. Hyaluronic acid has been proven to be shown in involvement in various stages of wound healing from promoting initial inflammation, granulation tissue formation tissue, keratinocyte migration and proliferation. The hyaluronic acid cream can be utilised as an alternative to promote ideal healing by protecting the wound from detrimental changes, providing or maintaining a damp environment and remarkably reducing microbial load .hence from our study, the hyaluronic acid cream benefits in the healing of acute maxillofacial wounds.

Utilization of smartphone and tablet camera photographs to predict healing of diabetes-related foot ulcers

The objective of this study was to build a machine learning model that can predict healing of diabetes-related foot ulcers, using both clinical attributes extracted from electronic health records (EHR) and image features extracted from photographs. The clinical information and photographs were collected at an academic podiatry wound clinic over a three-year period. Both hand-crafted color and texture features and deep learning-based features from the global average pooling layer of ResNet-50 were extracted from the wound photographs. Random Forest (RF) and Support Vector Machine (SVM) models were then trained for prediction. For prediction of eventual wound healing, the models built with hand-crafted imaging features alone outperformed models built with clinical or deep-learning features alone. Models trained with all features performed comparatively against models trained with hand-crafted imaging features. Utilization of smartphone and tablet photographs taken outside of research settings hold promise for predicting prognosis of diabetes-related foot ulcers.

Smartphone-based photographic wound documentation improves the quality of medical accounting in orthopedic and plastic surgery

HintergrundDie Fotodokumentation von offenen Frakturen, Wunden, Dekubitalulzera, Tumoren oder Infektionen ist ein wichtiger Bestandteil der digitalen Patientenakte. Bisher ist unklar, welchen Stellenwert diese Fotodokumentation bei der Abrechnungsprüfung durch den Medizinischen Dienst der Krankenkassen (MDK) hat.FragestellungKann eine Smartphone-basierte Fotodokumentation die Verteidigung von erlösrelevanten Diagnosen und Prozeduren sowie der Verweildauer verbessern?Material und MethodenAusstattung der Mitarbeiter mit digitalen Endgeräten (Smartphone/Tablet) in den Bereichen Notaufnahme, Schockraum, OP, Sprechstunden sowie auf den Stationen. Retrospektive Auswertung der Abrechnungsprüfung im Jahr 2019 und Identifikation aller Fallbesprechungen, in denen die Fotodokumentation eine Erlösveränderung bewirkt hat.ErgebnisseVon insgesamt 372 Fallbesprechungen half die Fotodokumentation in 27 Fällen (7,2 %) zur Bestätigung eines Operationen- und Prozedurenschlüssels (OPS) (n = 5; 1,3 %), einer Hauptdiagnose (n = 10; 2,7 %), einer Nebendiagnose (n = 3; 0,8 %) oder der Krankenhausverweildauer (n = 9; 2,4 %). Pro oben genanntem Fall mit Fotodokumentation ergab sich eine durchschnittliche Erlössteigerung von 2119 €. Inklusive Aufwandpauschale für die Verhandlungen wurde somit ein Gesamtbetrag von 65.328 € verteidigt.DiskussionDer Einsatz einer Smartphone-basierten Fotodokumentation kann die Qualität der Dokumentation verbessern und Erlöseinbußen bei der Abrechnungsprüfung verhindern. Die Implementierung digitaler Endgeräte mit entsprechender Software ist ein wichtiger Teil des digitalen Strukturwandels in Kliniken.

Classification of 2 distinct wound types in recessive dystrophic epidermolysis bullosa: A retrospective and cohort natural history study

To the Editor: Recessive dystrophic epidermolysis bullosa (RDEB) is a rare genodermatosis that causes severe wounds with a poorly understood natural history.1Bruckner-Tuderman L. Mellerio J.E. Wound healing in epidermolysis bullosa.Br J Dermatol. 2017; 177: e193-e195Crossref PubMed Scopus (7) Google Scholar It is understood that some wounds heal within weeks to months and that some heal and relapse.1Bruckner-Tuderman L. Mellerio J.E. Wound healing in epidermolysis bullosa.Br J Dermatol. 2017; 177: e193-e195Crossref PubMed Scopus (7) Google Scholar In a previous survey of 1226 wounds in 85 patients with RDEB, 76% healed within 8 weeks, and 24% were present for longer than 8 weeks.2Eng V. Solis D. Gorell E. et al.Patient-reported outcomes and quality of life in recessive dystrophic epidermolysis bullosa: a global cross-sectional survey.J Am Acad Dermatol. 2020; https://doi.org/10.1016/j.jaad.2020.03.028Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar Respondents were able to classify these wounds into 2 groups.2Eng V. Solis D. Gorell E. et al.Patient-reported outcomes and quality of life in recessive dystrophic epidermolysis bullosa: a global cross-sectional survey.J Am Acad Dermatol. 2020; https://doi.org/10.1016/j.jaad.2020.03.028Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar To explore these wound types, a retrospective evaluation and cross-sectional patient survey was performed at Stanford University. In cohort 1, serial wound photographs obtained over a mean of 36 weeks (maximum, 72 weeks) were evaluated. Surface area was quantified by using digital software (ImageJ, National Institutes of Health; VECTRA, Canfield; and Tissue Analytics, Net Health). Wounds that underwent investigational treatments were excluded. A cutoff of 12 weeks was hypothesized to define chronic open wounds.3Kyaw B.M. Jarbrink K. Martinengo L. Car J. Harding K. Schmidtchen A. Need for improved definition of “chronic wounds” in clinical studies.Acta Derm Venereol. 2018; 98: 157-158Crossref PubMed Scopus (30) Google Scholar Wounds that healed within 12 weeks but subsequently reblistered in the same location were defined as recurrent. Wounds were classified based on patient self-report and review by 2 dermatologists. In cohort 2, patients completed a survey on wound characteristics and patient-reported outcomes on up to 3 wounds of each type, with a 75% (30/40) response rate (Supplemental Methods; available via Mendeley at https://data.mendeley.com/datasets/f666xk8frd/1). A subset (n = 22) completed both evaluations, with a 78% concordance between participants and investigators for wound type and Spearman correlation coefficient of 0.70 for wound surface area. Both cohorts had similar demographics (Supplemental Table I; available via Mendeley at https://data.mendeley.com/datasets/f666xk8frd/1). Overall, 251 wounds were evaluated; 37% (93/251) were chronic open wounds, and 63% (158/251) were recurrent (Supplemental Table II; available via Mendeley at https://data.mendeley.com/datasets/f666xk8frd/1). Chronic open wounds had a larger mean surface area than recurrent wounds (cohort 1: 118.4 vs 26.0 cm2, P < .01; Cohort 2: 66.3 vs 44.7 cm2, P < .01). Fig 1 illustrates the relatively stable surface area of chronic wounds over time in contrast to the dynamic changes of recurrent wounds. Chronic open wounds were significantly more painful than recurrent wounds (Supplemental Table II). No chronic open wounds healed during the study period. Cohort 2 participants reported recurrent wound healing in 6.3 ± 13 weeks and reblistering in 3.2 ± 6 weeks. The mean time between photographs in cohort 1 was 15 ± 19 weeks; thus, time to healing and reblistering was not captured in this group. This study defines 2 distinct RDEB wound types: chronic open wounds and recurrent wounds. This characterization is important when designing therapeutic trials and ensuring similarity of treatment arms. A previous clinical trial failed wherein 50% of wounds in the placebo arm healed, likely because of the inclusion of recurrent wounds that healed on their own within weeks.4Murrell D.F. Paller A.S. Bodemer C. et al.Wound closure in epidermolysis bullosa: data from the vehicle arm of the phase 3 ESSENCE Study.Orphanet J Rare Dis. 2020; 15: 190Crossref PubMed Scopus (1) Google Scholar In RDEB, chronic open wounds lead to complications such as infection and aggressive squamous cell carcinoma.1Bruckner-Tuderman L. Mellerio J.E. Wound healing in epidermolysis bullosa.Br J Dermatol. 2017; 177: e193-e195Crossref PubMed Scopus (7) Google Scholar Their chronicity is likely multifactorial, related to sustained trauma, bacterial colonization, the itch-scratch cycle, inflammation, impaired cell proliferation, and stem cell depletion.5Cianfarani F. Zambruno G. Castiglia D. Odorisio T. Pathomechanisms of altered wound healing in recessive dystrophic epidermolysis bullosa.Am J Pathol. 2017; 187: 1445-1453Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar Additional study is underway with frequent monitoring of wounds to evaluate time to healing and reblistering in recurrent wounds. Future studies are needed to explore the optimal cutoff between recurrent and chronic open wounds to develop prognostic predictors for both types of wounds and develop early clinical interventions to reduce wound burden.

Ultrasound assessment of deep tissue on the wound bed and periwound skin: A classification system using ultrasound images

AimsGiven the utility of ultrasonography in assessing pressure injury, some ultrasonographic findings have already been used as indicators of deep tissue pressure injury. Despite reports showing that a cloud-like ultrasonographic pattern reflected the presence of deep tissue necrosis, identifying cloud-like patterns was difficult given the presence of similar findings, such as a cobblestone-like pattern. This case series reports patients with pressure injuries who presented with a cloud-like (five cases) and cobblestone-like (four cases) pattern during ultrasonography. MethodsThis study was conducted at a Japanese university hospital. Participants included patients who underwent routine examination by an interdisciplinary pressure injury team. Pressure injury severity was assessed using the DESIGN-R® scoring system and the wound size were measured using ImageJ software based on the wound photograph. ResultsAmong the five cases showing a cloud-like pattern upon ultrasonography, all exhibited an increase in the total DESIGN-R® score, while three exhibited an increase in wound size. On the other hand, all four cases showing a cobblestone-like pattern displayed no increase in the total DESIGN-R® score and a decrease in wound size. ConclusionThis study suggested that distinguishing between cloud-like and cobblestone-like ultrasonography patterns is necessary for determining the presence or absence of deep tissue pressure injury. In order to comprehensively assess pressure injuries with ultrasonography, future studies should be conducted in a large number of participants.

A Unified Framework for Automatic Detection of Wound Infection with Artificial Intelligence

Background: The surgical wound is a unique problem requiring continuous postoperative care, and mobile health technology is implemented to bridge the care gap. Our study aim was to design an integrated framework to support the diagnosis of wound infection. Methods: We used a computer-vision approach based on supervised learning techniques and machine learning algorithms, to help detect the wound region of interest (ROI) and classify wound infection features. The intersection-union test (IUT) was used to evaluate the accuracy of the detection of color card and wound ROI. The area under the receiver operating characteristic curve (AUC) of our model was adopted in comparison with different machine learning approaches. Results: 480 wound photographs were taken from 100 patients for analysis. The average value of IUT on the validation set with fivefold stratification to detect wound ROI was 0.775. For prediction of wound infection, our model achieved a significantly higher AUC score (83.3%) than the other three methods (kernel support vector machines, 44.4%; random forest, 67.1%; gradient boosting classifier, 66.9%). Conclusions: Our evaluation of a prospectively collected wound database demonstrates the effectiveness and reliability of the proposed system, which has been developed for automatic detection of wound infections in patients undergoing surgical procedures.

“Low cost, modified negative pressure wound therapy in infected orthopaedic wounds: can it be as effective as its costly counterparts?”

BackgroundInfected wounds pose a great financial burden on our healthcare system. Negative pressure wound therapy (NPWT) has brought a paradigm shift in the management of these wounds. However, availability and high cost of a conventional NPWT system remains a challenge. We carried out this study to assess whether we can replicate functioning of the conventional NPWT system using resources which are easily available in most hospitals and determine the clinical efficacy and cost effectiveness of the same. Material and methodsA prospective study was conducted in the orthopaedic department at our tertiary care institute from January 2018 to December 2019. Fifty six patients with contaminated or infected orthopaedic wounds were included in the study. Wound dressings were carried out by modified negative pressure therapy and their results were studied. ResultsThe study group consisted of 41 males and 15 females. Duration of stay in hospital ranged from 6 to 37 days, with average duration of 14.05 days. Wound closure was achieved by secondary suturing in 18 (32.2%) of the cases and split thickness skin grafting in 38 (67.8%) of the cases. Wound assessment done using the revised Photographic wound assessment tool revealed an average of 60% reduction in scores, post procedure. The average cost of the dressing could be considerably reduced during the study by the use of available material. ConclusionThrough our study we describe a simple and effective method of application of negative pressure dressings which may be beneficial in low resource settings. Our method is easily reproducible and does not require expertise for its application, at the same time it is cost effective and efficient in wound care.

Comparative evaluation of wound healing activity of tilvadi ghrita and durva ghrita on diabetic wound model in rats

Previous studies proved the wound healing potential of Tilvadi Ghrita (TG) and Durva Ghrita (DG) on normal wounds, so this study was conducted to investigate wound healing activity of TG and DG on diabetic wound model in rats. Forty-eight adult female Wistar rats in eight groups were used. Alloxan was used to induce diabetes in diabetic groups. Excision wound was made on the dorsal shaved surface of rats, and then Framycetin sulfate cream (FSC) 10%, TG and DG were applied in control and treatment groups. While in normal control and diabetic control groups, no medication was done. Wound photographs were taken on alternative days to evaluate wound healing. Percentage wound contraction, the effect on wound size, and epithelization period parameters were studied. Ghritas were investigated for their preliminary phytochemicals, Physico-chemical properties, skin irritation test, and wound healing activity in normal and diabetic rats. Data were expressed as mean ± SEM and analyzed using Two-way ANOVA followed by Bonferroni’s multiple range test. Studies revealed that TG and DG do not cause any harmful skin reactions, so both ghritas were found to be safe for topical application. Both formulations showed better and fast healing as compared to untreated normal and diabetic control groups. After comparative investigation, it was observed that DG possesses higher wound healing potential in normal and diabetic groups with comparison to TG. Wound healing action in normal and diabetic wounds, it endowed due to the presence of different phytoconstituents reported in the literature and proved to be beneficial in the management of wounds.