Wound Area Measurement Research Articles

Formulation and Clinical Evaluation of A Topical Dosage Form of Alkanna orientalis Root Extract for Management of Pressure Lesions: A Pilot Cross-Sectional Clinical Trial

Background: Pressure lesions are chronic wounds causing the development of infection and inflammation into deeper structures and finally necrosis. In Persian medicine, Alkanna orientalis (Boraginaceae) has been used for centuries as a naturally derived remedy for managing lesions. A cross-sectional pilot clinical trial was conducted to assess the wound healing effect of an ointment made of chloroform extract of roots of A. orientalis (CERAO). Methods: Sixty patients (36 men and 24 women) diagnosed with bedsore staging 1-2 entered the study for one year. They were divided into two groups of control and treatment with equal proportions. The control group received conventional treatment from the hospital, including irrigation serum, mupirocin, phenytoin ointments, and gauze dressing. After rinsing and cleansing with normal saline, in the intervention group, patients received a thin layer of CERAO once daily for four weeks. Clinical outcomes were measured at weeks 2 and 4. Results: Recovery assessment was carried out by measuring wound area, days of epithelia formation, and complete wound closure. The difference between the two groups was statistically significant (P-value <0.05) in terms of the mentioned criteria. The recovery percentage was 26.7% and 60% for the control and treatment groups, respectively. In the control group, 16.7% of the study population experienced the development of wounds, while in the intervention group, wound progression was not observed. Conclusion: The results of this pilot study indicated that the clinical efficacy of CERAO could be promising and a replacement for conventional treatment of pressure ulcers.

Healing effect of decellularized human placenta and gelatin hydrogel on diabetic wound in animal model

Diabetic skin wounds are the most critical clinical issues that are mostly resistant to usual treatments and healing methods. The aim of this study was to investigate the healing effect of decellularized human placenta and gelatin hydrogel on the diabetic wound in an animal model. Dorsal-paired 8–10 mm diameter wounds were created in the male Wistar diabetic rats. The rats were divided into control untreated group and groups treated with gelatin, decellularized placenta, and “decellularized placenta + gelatin”. Macroscopic examination and wound area measurement were applied on days 0, 7, 14 and 21 days after treatment to evaluate wound healing. The data were analyzed using ANOVA. Wound area significantly decreased 7 days after treatment in gelatin, decellularized placenta and “decellularized placenta + gelatin” treated rats compared to control animals, however, there was no significant difference in wound area between gelatin, decellularized placenta and “decellularized placenta + gelatin” groups. There was no also significant difference between the groups 14 and 21 days after treatment. Conclusively, our findings show that the decellularized placenta has healing properties on diabetic skin wound comparable to gelatin hydrogel.

IL1β/ TNFα/COX-2/VEGF axis responsible for effective healing potential of C-glucoside xanthone (mangiferin) based ointment in immunocompromised rats

Present study was conducted to undermine the wound healing potential of mangiferin vis a vis its molecular dynamics in immunocompromised excisional rat model. 120 rats were randomly and equally divided into five groups viz. group I (Healthy control), group II (Immunocompromised control), group III (Immunocompromised group treated with silver sulphadiazine), group IV (Immunocompromised group treated with 2.5 %Mangiferin) and group V (Immunocompromised group treated with 5 %Mangiferin). Immuno compromised state was achieved following intramuscular injection of Hydrocortisone @ 80 mg/kg body weight. Study was conducted for a period of 28 days. Six animals from each group were humanely sacrificed at weekly interval till day 28th of study. Planimetric analysis, biochemical studies viz. hydroxyproline assay, total protein and DNA content, antioxidative potential through LPO assay was done along with molecular studies involving expression profiling of IL1β, TNFα and COX-2 and Immunohistochemistry of angiogenic marker i.e. VEGF was performed to undermine the pharmacodynamics of mangiferin. Histopathological studies including H&E and Masson’s Trichome was also performed to study histoarchitectural changes in wound healing and reparative process following application of mangiferin ointment. Study revealed significant (P ≤ 0.05) reduction in wound area measurement and significant (P ≤ 0.05) increase in wound contraction (%) following mangiferin administration in immunocompromised rats. Hydroxyproline, DNA and total protein showed significant (P ≤ 0.05) increase in skin tissues of mangiferin treated immunocompromised rats. LPO assay revealed significant (P ≤ 0.05) reduction in mangiferin treated animals. Histopathological studies of skin tissues revealed complete restoration advocating grade III of healing in 2.5% mangiferin treated group. Higher expression and strong signal intensity of VEGF was noticed in 2.5% mangiferin treatment group along with significant (P ≤ 0.05) upregulation IL1β and TNFα on day 7 in 2.5% mangiferin treatment group with significant (P ≤ 0.05) down regulation of COX-2 in mangiferin treatment group as compared to other groups i.e. group II and III. It is concluded from our study that mangiferin facilitates wound healing through improved wound closure, organized deposition of collagen deposition and granulation matrix formation.

Effect of Polycaprolactone Scaffold Containing Myrtus Communis Extract and Silver Nanoparticles on the Burn Wound Infection Induced by Methicillinresistant Staphylococcus Aureus in Rats

Background and Objectives: Regarding the important role of Staphylococcus aureus in burn wound infection, the present study aims to investigate of the effect of Polycaprolactone (PCL) scaffold containing Myrtus communis extract and silver nanoparticles on the healing of burn wound infections induced by Methicillin-Resistant Staphylococcus Aureus (MRSA) in rats. Methods: In this experimental study, 42 male Wistar rats were divided into seven groups of 6. After anesthesia, second-degree burns on the back of the rats’ necks were created and MRSA was then injected into the wound area. The rats’ wounds were treated daily with nanofiber PCL containing Myrtus communis extract and silver nanoparticles. Antimicrobial properties, wound healing percentage, wound area, malondialdehyde and nitric oxide levels, and total antioxidant capacity were measured. Data were analyzed in GraphPad software using Tukey’s test and ANOVA. Results: The wound area measurement showed the better effects on would healing in the groups treated by PCL+Myrtus communis extract and PCL+Myrtus communis extract+silver nanoparticles compared other groups. In bacteriological studies, the groups treated by PCL+Myrtus communis extract and PCL+Myrtus communis extract+silver nanoparticle showed more reduced bacterial growth compared to the PCL alone and positive control groups. Moreover, biochemical tests showed a decrease in malondialdehyde and nitric oxide levels in rats treated by PCL+Myrtus communis extract compared to other groups. Conclusion: Myrtus communis extract and silver nanoparticles can cause changes in PCL properties, which have an important role in reducing the time required for wound healing and in preventing the progression of MRSA-induced wound infection

A Dose Optimization Study of Marantodes pumilum (Blume) Kuntze Extracts for Wound Healing Effect in Animal Model

Objective: This study was done in the ovariectomized rat model to optimize the dose ofMarantodespumilum (MP) for the treatment of open wound healing activities. Materials and Methods: Total fifty-six rats were taken for this study which was split into four groups based on four extracts such as Marantodes pumilum var. pumila (MPvp) leaf and root extracts and Marantodes pumilum var. alata (MPva) leaf and root extracts; each group contains fourteen rats. Each group was further divided into seven subgroups with equally distributed rats which consisted with one control group without treatment (Control) and six treated groups with different concentrations: 0.1% Conc, 0.5% Conc, 1.0% Conc, 2.0% Conc, 3.0% Conc and 4.0% Conc of each MP extract. After punch biopsy, rats were treated with ointment prepared by cetomacrogol emulsifying agent and MP extract on daily basis, beginning from the wound creation until healed completely. The parameters studied were the macroscopic observation andthe wound area measurement. Results: Wounds with treated 1.0% and 4.0% Conc of MPvpleaf and root extracts and 2.0%, 3.0% and 4.0% Conc of MPvaleaf and root extracts were healed completely at day 9, whereas wounds of control groups were healed at day 12 for each extract group. The wound area was significantly reduced in the treated groups with 1.0% and 4.0% Conc ofMPvpleaf and root extracts (p < 0.05) and 2.0%, 3.0% and 4.0% Conc of MPvaleaf and root extracts (p < 0.05) than their respective control group. Conclusion: The dose of 1.0% concentration for both leaf and root extracts of MPvp and 2.0% concentration for both leaf and root extracts of MPva exhibited the best effect to expedite for open wound healing compared to control group and other concentrations in the ovariectomized rat model. Bangladesh Journal of Medical Science Vol. 21 No. 03 July’22 Page: 659-668

19 Minced Skin Grafts Can Be Expanded up to 500 Times to Re-epithelialize Full-thickness Burns

IntroductionDeep and large burns require hospitalization and, without exception, surgical treatment. Skin graft expansion in major burns currently is restricted to a 1:6 expansion ratio (possibly 1:9) by current methods. For this reason, skin transplants are limited by donor site availability for patients with extensive burns, who may have only small areas of healthy skin for use as donor sites. The objective of this project is to demonstrate the efficacy of pixel grafting, to produce split-thickness skin grafts (STSG) and dermal grafts which can be expanded at least 100 times (1 cm2 donor skin will cover 100 cm2). Pixel grafts are skin grafts that are prepared from split-thickness donor skin that is 0.3 mm (12/1000 of an inch) thick and minced into pieces that are 0.3 x 0.3 mm. The methodology relies on mincing a small area of donor skin using a hand-held mincer to create uniform skin pieces, each of which will serve as a small center of skin regeneration.MethodsDeep partial-thickness burns were created on the dorsum of Yorkshire pigs. Three days post injury the burns were debrided and grafted with epidermal/dermal and dermal pixel grafts using expansion ratios from 1:2 to 1:500. The pixel grafts were prepared by harvesting 0.3 mm thick skin grafts from the same donor site going down in depth (Layer 1: STSG; Layer 2: dermal graft). Subsequently, the grafts were minced to 0.3 x 0.3 x 0.3 mm pixel grafts, suspended in a small volume of hydrogel and transplanted onto debrided porcine burn wounds. Healing was monitored up to 28 days and biopsies were collected on days 6, 10 and 14. The wounds were excised and fixed in formalin for histologic analysis. In addition, to measure wound area reduction and wound depth, wound images were taken. Multiple wound healing parameters were used to assess the quality of healing and the results were compared to STSG (standard of care treatment).ResultsHistology demonstrated that when both STSG pixel grafts and dermal grafts were transplanted onto porcine full-thickness wounds in a 1:2 ratio they were able to fully re-epithelialize the wounds in 14 days. At day 14, re-epithelialization-% using other expansion ratios varied from 46 % (1:500) to 64 % (1:10) and by day 28 all the wounds were fully re-epithelialized. Wound images obtained at different time points showed that by day 28 all the pixel graft grafted wounds had reduced in area efficiently, from 70 % (dermal pixel grafts 1:50) to 81% (STSG 1:100). No statistically significant differences were observed between the pixel graft study groups and STSG (standard of care).ConclusionsThis study concluded that both epidermal/dermal and dermal pixel grafts can be suspended in a hydrogel and transplanted onto wounds regardless of orientation (dermal side up or down), making the transplantation greatly simplified.

Lokal Hümik Uygulamasının Yara İyileşmesi Üzerine Etkisinin Değerlendirilmesi

Background: The purpose of the present study was to examine the effects of topical humic acid application on healing in oral mucosa wound in rats. Material and Methods A total of 12-week-old 72 Wistar male rats weighing 280-300 gr were used in the study. The rats were randomly grouped in 4 groups as the Control Group (K) to which no applications were made, Chlorhexidine (0.12%) Group (CHX), 80 mg/kg Humic Acid Group (HA80), and 150 mg/kg Humic Acid Group (HA150). Mucosal defects of 5-mm-diameter were induced with punch in the palatal areas of the rats. These groups were further divided into 3 sub-groups to be sacrificed on days 7, 14 and 21. Epithelization, ülceration, polymorphic nuclear leukocytes (PNL), mononuclear cells (MNL), fibroblast and vascularization were examined in histopathologic evaluations. In addition, photos of the tissue samples were taken and transferred to the computer medium for histo-morphometric examinations. Results As a result of the statistical analyses, no significant differences were detected among the groups in terms of epithelization degree, PNL and MNL cell infiltration on days 7, 14 and 21. The ulcerated areas were low in HA150 Group compared to the other groups, and there was a significant difference in this respect (p<0.05). Vascularization degrees were evaluated, the K Group and HA150 Group showed better results on day 7 (p<0.05). On days 14 and 21, no significant differences were detected among the groups (p>0.05). Wound area measurement scores were lower in HA150 Group compared to the other groups, and this result showed that the healing in HA150 Group was better (p<0.05). Conclusions As a result of the present study, it was found that humic acid increased wound healing in oral cavity.

Efficacy of topical honey compared to systemic gentamicin for treatment of infected war wounds in a porcine model: A non-inferiority experimental pilot study

BackgroundIn armed conflicts, infected wounds constitute a large portion of the surgical workload. Treatment consists of debridements, change of dressings, and antibiotics. Many surgeons advocate for the use of honey as an adjunct with the rationale that honey has bactericidal and hyperosmotic properties. However, according to a Cochrane review from 2015 there is insufficient data to draw any conclusions regarding the efficacy of honey in treatment of wounds. We, therefore, decided to evaluate if honey is non-inferior to gentamicin in the treatment of infected wounds in a highly translatable porcine wound model. Material and methods50 standardized wounds on two pigs were infected with S. aureus and separately treated with either topically applied Manuka honey or intramuscular gentamicin for eight days. Treatment efficacy was evaluated with quantitative cultures, wound area measurements, histological, immunohistochemical assays, and inflammatory response. ResultsTopically applied Manuka honey did not reduce bacterial count or wound area for the duration of treatment. Intramuscular gentamicin initially reduced bacterial count (geometric mean 5.59*¸0.37 – 4.27*¸0.80 log10 (GSD) CFU/g), but this was not sustained for the duration of the treatment. However, wound area was significantly reduced with intramuscular gentamicin at the end of treatment (mean 112.8 ± 30.0–67.7 ± 13.2 (SD) mm2). ANOVA-analysis demonstrated no variation in bacterial count for the two treatments but significant variation in wound area (p<0.0001). The inflammatory response was more persistent in the pig with wounds treated with topically applied Manuka honey than in the pig treated with intramuscular gentamicin. ConclusionAt the end of treatment S. aureus count was the same with topically applied Manuka honey and intramuscular gentamicin. The wound area was unchanged with topically applied Manuka honey and decreased with intramuscular gentamicin. Topically applied Manuka honey could consequently be non-inferior to intramuscular gentamicin in reducing S. aureus colonization on the wound's surface, but not in reducing wound size. The use of Manuka honey dressings to prevent further progression of a wound infection may therefore be of value in armed conflicts, where definite care is not immediately available.

Experimental Study on Wound Area Measurement with Mobile Devices.

Healthcare treatments might benefit from advances in artificial intelligence and technological equipment such as smartphones and smartwatches. The presence of cameras in these devices with increasingly robust and precise pattern recognition techniques can facilitate the estimation of the wound area and other telemedicine measurements. Currently, telemedicine is vital to the maintenance of the quality of the treatments remotely. This study proposes a method for measuring the wound area with mobile devices. The proposed approach relies on a multi-step process consisting of image capture, conversion to grayscale, blurring, application of a threshold with segmentation, identification of the wound part, dilation and erosion of the detected wound section, identification of accurate data related to the image, and measurement of the wound area. The proposed method was implemented with the OpenCV framework. Thus, it is a solution for healthcare systems by which to investigate and treat people with skin-related diseases. The proof-of-concept was performed with a static dataset of camera images on a desktop computer. After we validated the approach’s feasibility, we implemented the method in a mobile application that allows for communication between patients, caregivers, and healthcare professionals.

Diabetic Foot Wounds Treated With Human Amniotic Membrane and Low-level Laser Therapy: A Pilot Clinical Study

Low-level laser therapy (LLLT) and human amniotic membrane (HAM) application have been shown to be viable options for use in wound healing. This study sought to compare LLLT and HAM to a control treatment (hydrogel, saline, and gauze) in persons with diabetes mellitus (DM) and foot ulcers. Using a prospective pilot clinical study design, patients receiving care at a health center that specializes in the treatment of diabetic foot wounds between November 2016 and August 2017 were recruited. Eligible patients had to be 30 to 59 years of age; diagnosed with type 2 DM (postprandial capillary glucose levels between 140 and 350 mg/dL); and have uninfected, granulating stage 2 or 3 foot ulcers measuring less than 7 cm by 3 cm. Immunosuppressed and malnourished patients or those with neoplasms or in critical condition were not eligible to participate. Patients received the control treatment (2 mg hydrogel, saline, and gauze), HAM (patches of thawed HAM, applied with overlapping edges), or LLLT (phototherapy session, 2 mg hydrogel, saline, and gauze) for 28 days. Variables, wound area measurements, Pressure Ulcer Scale for Healing (PUSH) scores, and Visual Analog Scale (VAS) scores were used to assess wound improvement progress and pain on days 7, 14, 21, and 28. Descriptive statistics were used to analyze the participant anthropometric and clinical profiles. The Kolmogorov-Smirnov test was used to analyze the sample distribution. The Kruskal-Wallis test with Dunn's post-test was used to evaluate differences in PUSH and VAS scores and wound size for intergroup analysis, and the Mann-Whitney U test was used for the same outcomes in intragroup analysis. The level of significance was 5% (P < .05). Twenty-seven (27) patients participated (mean age, 51.4 years; mean body mass index, 26.5 kg/m2), with 9 patients in each treatment group. No statistically significant differences were noted in clinical or anthropometric variables among the groups, but mean baseline wound areas were different (2.6 cm² for the control, 1.9 cm² for the LLLT, and 5.5 cm² for the HAM groups). Intragroup comparisons showed a significant reduction in PUSH score in the LLT group between days 0 and 21 (8.2 vs 4.9; P < .01) and days 21 to 28 (4.9 vs 3.2; P < .001). In all treatment groups the percent reduction was significantly different between days 7 and 28. No outcomes were significantly different between groups. Diabetic foot ulcer wound area as well as PUSH and VAS scores showed more improvement for patients with DM receiving LLLT or HAM than for the control group, but the differences were not significant. Larger studies are needed to compare these treatment modalities.

27591 Quantification of the area of affection and inflammation of hidradenitis suppurativa using a dedicated mobile app

Background: Current classification systems for hidradenitis suppurativa (HS) rely on qualitative measurements and make the precise assessment of treatment outcomes challenging. Except for the HASI score, no other classification system systematically measures the affected area, thus they cannot be dynamically used to monitor response to treatment. We hypothesize that by pairing the use of a dedicated mobile application for measuring wound area and infrared thermal (IRT) imaging, a more comprehensive evaluation of the severity of HS can be achieved.

Low Intensity Shockwave Treatment Modulates Macrophage Functions Beneficial to Healing Chronic Wounds.

Extracorporeal Shock Wave Therapy (ESWT) is used clinically in various disorders including chronic wounds for its pro-angiogenic, proliferative, and anti-inflammatory effects. However, the underlying cellular and molecular mechanisms driving therapeutic effects are not well characterized. Macrophages play a key role in all aspects of healing and their dysfunction results in failure to resolve chronic wounds. We investigated the role of ESWT on macrophage activity in chronic wound punch biopsies from patients with non-healing venous ulcers prior to, and two weeks post-ESWT, and in macrophage cultures treated with clinical shockwave intensities (150–500 impulses, 5 Hz, 0.1 mJ/mm2). Using wound area measurements and histological/immunohistochemical analysis of wound biopsies, we show ESWT enhanced healing of chronic ulcers associated with improved wound angiogenesis (CD31 staining), significantly decreased CD68-positive macrophages per biopsy area and generally increased macrophage activation. Shockwave treatment of macrophages in culture significantly boosted uptake of apoptotic cells, healing-associated cytokine and growth factor gene expressions and modulated macrophage morphology suggestive of macrophage activation, all of which contribute to wound resolution. Macrophage ERK activity was enhanced, suggesting one mechanotransduction pathway driving events. Collectively, these in vitro and in vivo findings reveal shockwaves as important regulators of macrophage functions linked with wound healing. This immunomodulation represents an underappreciated role of clinically applied shockwaves, which could be exploited for other macrophage-mediated disorders.

Effect of active resisted exercise on plantar ulcer in subjects with leprosy

Background of the study: Leprosy is a wide spread infectious disease caused by mycobacterium leprae & usually starts as a patch on the skin, but it can also affect & damage the nerves leading to secondary impairments in the face, hands and feet. Plantar ulceration is one of the common impairment occurring in subjects of leprosy, which punched out ulcer surrounded by thickened skin due to direct pressure, shearing force, direct injury, heat. It may occur as sinuses or as shallow ulcers involving the tissues at various level and usually heal with good wound care and dressings, but takes longer time.Objective of the study: To evaluate and compare the improvement of healing of plantar ulcer during 4-week intervention period in leprosy subjects treated with active resisted exercise vs subjects treated conventionally. MethodsDesign: Quasi randomised trial.Study settings: The central leprosum, govt hospital, magadi road, bengaluru.Sample size: 26Outcome measures: Wound area measurement in mm2 on a graph paper.Results: The mean value of ulcer area at baseline for group A was 1038.15(599.77) mm2 & group B was 997.07(804.47) mm2 and at day 30 the value for group A is 318(311.65) mm2 & for group B is 720.84(673.19) mm2. This study showed a significant improvement in reduction of ulcer area in both the groups. Group A demonstrated significantly better improvements than Group B. Conclusion: Active resisted exercise showed a significant improvement in healing of planter ulcer of leprosy subjects compared to control group

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.

Functional Imaging in Wounds: Imaging Modalities of Today and Tomorrow

Wound care is a multidisciplinary field with significant economic burden to our healthcare system. Not only does wound care cost the US healthcare system $20 billion annually, but wounds also remarkably impact the quality of life of patients; wounds pose significant risk of mortality, as the five-year mortality rate for diabetic foot ulcers (DFUs) and ischemic ulcers is notably higher compared to commonly encountered cancers such as breast and prostate. Although it is important to measure how wounds may or may not be improving over time, the only relative “marker” for this is wound area measurement—area measurements can help providers determine if a wound is on a healing or non-healing trajectory. Because wound area measurements are currently the only readily available “gold standard” for predicting healing outcomes, there is a pressing need to understand how other relative biomarkers may play a role in wound healing. Currently, wound care centers across the nation employ various techniques to obtain wound area measurements; length and width of a wound can be measured with a ruler, but this carries a high amount of inter- and intrapersonal error as well as uncertainty. Acetate tracings could be used to limit the amount of error but do not account for depth, thereby making them inaccurate. Here, we discuss current imaging modalities and how they can serve to accurately measure wound size and serve as useful adjuncts in wound assessment. Moreover, new imaging modalities are also discussed and how up-and-coming technologies can provide important information on “biomarkers” for wound healing.

Wound surface area measurement methods

Assessment of progress in chronic wound healing is very important as it enables deciding when the applied therapy should be replaced with a more advanced one. Wound healing societies recommend using the rate in wound surface area reduction as a marker of the therapy effectiveness. If the wound surface area did not reduce by 50% or more in 4 weeks of standard treatment, advanced therapy options should be introduced. The decrease of wound surface area by 10–15% in a week may also be useful in estimating the probability of wound closure. There is a range of methods for wound surface area measurements that differ in the technology used, accuracy, repeatability, and level of required contact with the patient’s skin or wound itself. Technical advancement of these methods is very wide, from area estimation based on linear measurements to 3D techniques able to analyze skin curvature using sophisticated models. Some methods are based on specialized equipment, thus may be less useful in telemedicine than, for instance, those based on a smartphone with dedicated software. This review presents the current state-of-the-art methods in wound area measurements, presenting selected commercial devices and the latest developments.

A pilot study comparing two burn wound stereophotogrammetry systems in a paediatric population

BackgroundStereophotogrammetry (SPG) provides a more objective measurement of burn wound area than traditional clinical assessments. The recently developed Intel® RealSense™ D415/Wound Measure SPG system has yet to undergo formal evaluation in a paediatric population. MethodsA pilot study comparing the Intel® RealSense™ D415/Wound Measure to the previously validated LifeVizII®/DermaPix® SPG system, for burn assessment was conducted at a tertiary paediatric burn centre. Both systems were used to photograph and analyse the same acute wounds for each patient. Three independent raters measured wound area and perimeter. Level of agreement between systems and raters was estimated by calculating the intra-class correlation coefficient. ResultsWound area measurements were completed in both systems for 25 burns from 13 patients (median age, 2 years). The participants were mainly female (n = 9), with a median TBSA-B of 9% (IQR 3–20%). There was strong agreement between the systems 0.757 (95% CI 0.521, 0.885, p < 0.001). Within each SPG system, there was excellent inter-rater reliability. ConclusionThe Intel® RealSense™ D415/Wound Measure system may be a viable addition to the clinician’s toolkit in the assessment of paediatric burn wound area. As with other SPG systems, there were significant challenges measuring wounds to highly contoured surfaces.

Preparation and evaluation of chitosan-polyvinyl alcohol/polyhexamethylene guanidine hydrochloride antibacterial dressing to accelerate wound healing for infectious skin repair.

BackgroundWound infections, especially multidrug-resistant (MDR) bacterial infections, are a major challenge in clinical medicine.MethodsIn this study, a new type of antibacterial sponge was prepared from a solution containing a chitosan-polyvinyl alcohol (CTS-PVA) emulsion with added polyhexamethylene guanidine hydrochloride (PHMG) in a homogeneous medium using lyophilization technology. The antibacterial ability of and CTS-PVA/PHMG sponge against Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, Candida albicans, Methicillin-resistant Staphylococcus aureus, multidrug-resistant Pseudomonas aeruginosa, and multidrug-resistant Acinetobacter baumannii in vitro. The structure and physical properties were characterized. The sponge dressing was tested in a Pseudomonas aeruginosa-infected full-thickness mouse skin wound defect model. The effects were evaluated by wound area measurement and histological analysis.ResultsThe CTS-PVA/PHMG sponge showed broad-spectrum antibacterial ability, including for MDR bacterial stains from clinical sources, while maintaining excellent physicochemical properties, including a high swelling degree and good moisture retention capability. Scanning electron microscopy images displayed the surface morphology of the CTS-PVA/PHMG sponge dressing. The detection of the wound healing rate and histological analysis supported that the new dressing can alleviate the inflammation and accelerate the healing speed of infected wounds and in vivo.ConclusionsCTS-PVA/PHMG sponge shows broad-spectrum antibacterial activity, which can provide a new pathway for clinical prevention and treatment of superbug-infected wounds.

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.

STUDY TO EVALUATE THE EFFICACY OF PLATELET-RICH PLASMA INJECTION IN THE MANAGEMENT OF CHRONIC NONHEALING WOUNDS

Objective: The aim was to evaluate the efcacy of platelet-rich plasma (PRP) in treating chronic non healing wounds. Non healing ulcers are a signicant health problem with a high costs in Background: terms of human and material resources. The application of autologous PRP has been a signicant breakthrough for treating non healing ulcers ,as it is an easy and cost-effective method and provides the necessary growth factors that enhance wound healing. A prospective study was conducted from September 2018 to March 2020 at Narayana Medi Methodology: cal college. A total of 30 cases with chronic non healing ulcers of various causes (traumatic, diabetic, pressure, venous ulcers),at least six weeks old with wound area measurement between 2 cm2and 10 cm2are injected with autologous platelet-rich plasma injection twice weekly. Wound contraction was measured every 4th day and represented as a percentage of healing wound area and followed up for 6 weeks. The mean age± SD of the patients was 49.36±14.05.According to Results: the etiology, non healing ulcers are again classied as traumatic, diabetic, decubitus ulcers, venous and others (postoperative wounds, Hansen's disease)which constitutes 40%,27%,17%,3%,13% respectively. The healing rates of the various ulcers were monitored in weekly intervals till the sixth week. Among 30 patients,17 patients(57%) showed complete healing ,3 patients (10%) showed 99-90% healing ,5 patients (17%) showed 80-89% healing ,5 patients(17%) showed 80-89% healing ,4 patients (13%) showed 50-79% healing,1 patients (3%) showed &lt;50% healing. Area reduction was statistically signicant (p-value is &lt;0.001) Conclusion: Conventional therapies do not provide good healing for chronic nonhealing ulcers as they are not able to provide the necessary growth factors essential for the healing process.PRP is a safe, affordable, biocompatible, and simple OPD based procedure for treating nonhealing ulcers.