Monitoring Of Wound Healing Research Articles

Non-contact oxygen saturation monitoring for wound healing process using dual-wavelength simultaneous acquisition imaging system.

Here we report the fabrication of a noncontact pulse oximeter system based on a dual-wavelength imaging system and its oxygen saturation monitoring performance during wound healing. The dual-wavelength imaging system consists of 660nm and 940nm light-emitting diodes and a multi-spectral camera that simultaneously accepts visible and near-infrared images. Using the proposed system, images were acquired at 30 fps at both wavelengths, and photoplethysmography signals were extracted by specifying a specific region in the images. We removed the signals caused by small movements and smoothed them using the discrete wavelet transform and moving average filter. To confirm the feasibility of the proposed noncontact oxygen saturation system, a wound model was created using a hairless mouse and oxygen saturation was measured during wound healing. The measured values were compared and analyzed using a reflective animal pulse oximeter. Through a comparative analysis of these two devices, the error of the proposed system was evaluated and the possibility of its clinical application and wound healing monitoring through oxygen saturation measurement confirmed.

A Digital Tool for Measuring Healing of Chronic Wounds Treated with an Antioxidant Dressing: A Case Series

(1) Abstract: Wound monitoring is an essential aspect in the evaluation of wound healing. This can be carried out with the multidimensional tool HELCOS, which develops a quantitative analysis and graphic representation of wound healing evolution via imaging. It compares the area and tissues present in the wound bed. This instrument is used for chronic wounds in which the healing process is altered. This article describes the potential use of this tool to improve the monitoring and follow-up of wounds and presents a case series of various chronic wounds with diverse etiology treated with an antioxidant dressing. (2) Methods: A secondary analysis of data from a case series of wounds treated with an antioxidant dressing and monitored with the HELCOS tool. (3) Results: The HELCOS tool is useful for measuring changes in the wound area and identifying wound bed tissues. In the six cases described in this article, the tool was able to monitor the healing of the wounds treated with the antioxidant dressing. (4) Conclusions: the monitoring of wound healing with this multidimensional HELCOS tool offers new possibilities to facilitate treatment decisions by healthcare professionals.

Dual-crosslinked bioadhesive hydrogel as NIR/pH stimulus-responsiveness platform for effectively accelerating wound healing

Adhesive hydrogels have emerged as promising candidates to solve life-threatening infectious skin injuries. However, the inadequate mechanical characteristics and biological adherence limit the traditional wound dressing unable to adapt to high-frequency movement and real-time monitoring of wound healing, calling for the development of bioadhesive materials guided wound healing. In this work, a multifunctional bioadhesive hydrogel with double colorimetric-integrated of polyethylene glycol (PVA)-dextran (Dex)-borax-bromothymol blue (BTB)-fluorescein thiocyanate (FITC) and functionalization by tungsten disulfide-catechol nanozyme (CL/WS2) was created. Hydrogel is a perfect biological adhesive, which can achieve repeatable and strong tissue adhesion strength (8.3 ± 0.6 kPa), which is 1.66 times that of commercial dressings. Based on the strong biological adhesion of the hydrogel, a sensor is integrated into the hydrogel to collect visual image of bacterial infection from a smartphone and transform it into an on-site pH signal for remote evaluation of the wound's dynamic status in real time. Ultimately, the adhesiveness hydrogel has high worth in managing the burden related to wound healing and paving the way for intelligent wound management in the future.

Flexible and temperature-responsive hydrogel dressing for real-time and remote wound healing monitoring.

Wound management is highly clinically desirable due to the complexity and diversity of the wound repair process. However, it is still a major clinical challenge to develop a wound dressing with the capabilities of real-time and remote monitoring during wound healing. Herein, we have designed a polymer-based wound dressing in the form of a conductive, soft, temperature-responsive, antibacterial and biocompatible hydrogel, which is composed of polyacrylic acid (PAA)-grafted poly(N-isopropylacrylamide) (PNIPAM), vinyl-based polyacrylamide (PAM) and silver nanowires (AgNWs). In this hydrogel dressing, PAA-grafted PNIPAM acts as conformal interface and intrinsic temperature-responsive matrix, PAM helps to construct semi-penetrating polymer networks (SIPNs) to improve the mechanical properties, while the AgNWs introduce a three-dimensional conductive hydrogel network with antibacterial properties and sensing properties. The constructed hydrogel matrix was connected to a Bluetooth module to transmit the temperature changes wirelessly to a smart device. The design integrating a conductive hydrogel dressing with a wireless transmission module realized the real-time and wireless monitoring of the wound temperature, which is helpful to provide an early diagnosis of infection. This proof-of-concept study is highly promising in the development of new strategies to significantly improve wound management and other pathological diagnostics or treatments.

Postintervention monitoring of peripheral arterial disease wound healing using dynamic vascular optical spectroscopy.

Due to the persistence of chronic wounds, a second surgical intervention is often necessary for patients with peripheral arterial disease (PAD) within a year of the first intervention. The dynamic vascular optical spectroscopy system (DVOS) may assist physicians in determining patient prognosis only a month after the first surgical intervention. We aim to assess the DVOS utility in characterizing wound healing in PAD patients after endovascular intervention. The DVOS used near-infrared light ( ) to record hemodynamic response to a cuff inflation in 14 PAD patients with lower limb ulcers immediately before, immediately after, and at a first follow-up 3 to 4 weeks after intervention. Ankle-brachial index (ABI) and arterial duplex ultrasound (A-DUS) measurements were obtained when possible. The total hemoglobin plateau time differed significantly between patients with ulcers that reduced in size ( ) and patients with ulcers that did not ( ) 3 to 4 weeks after intervention ( ). Data correlated strongly (89% sensitivity, 100% specificity, and ) with long-term wound healing. ABI and A-DUS measurements were not statistically associated with wound healing. This pilot study demonstrates the potential of the DVOS to aid physicians in giving accurate long-term wound healing prognoses 1 month after intervention.

Mueller Matrix Microscopy for In Vivo Scar Tissue Diagnostics and Treatment Evaluation.

Scars usually do not show strong contrast under standard skin examination relying on dermoscopes. They usually develop after skin injury when the body repairs the damaged tissue. In general, scars cause multiple types of distress such as movement restrictions, pain, itchiness and the psychological impact of the associated cosmetic disfigurement with no universally successful treatment option available at the moment. Scar treatment has significant economic impact as well. Mueller matrix polarimetry with integrated autofocus and automatic data registration can potentially improve scar assessment by the dermatologist and help to make the evaluation of the treatment outcome objective. Polarimetry can provide new physical parameters for an objective treatment evaluation. We show that Mueller matrix polarimetry can enable strong contrast for in vivo scar imaging. Additionally, our results indicate that the polarization stain images obtained form there could be a useful tool for dermatology. Furthermore, we demonstrate that polarimetry can be used to monitor wound healing, which may help prevent scarring altogether.

Biodegradable silk-curcumin composite for sustained drug release and visual wound monitoring

The production of biodegradable dressing capable of sustained drug release, along with the monitoring of wound conditions, represents new heights of multifunctional platforms for wound care. The reported curcumin-loaded silk fibroin has shown sustained drug release over the time of 10 days through a non-Fickian diffusion process satisfying Korsmeyer-Peppas' model along with the visual monitoring of wound healing through notable color variation with pH as a biomarker. The superhydrophobic nature (water contact angle = 163.7) of the SF, along with the lipophilicity (CA = 0 (Blood)) and hygroscopic nature prevents wetting of wound surface, whereas the excess exudates from wounds are absorbed along with sufficient water and oxygen permeability. The pH responsiveness as a result of the keto-enol tautomerism in curcumin was utilized for wound monitoring through visual indication enabling even ordinary people to detect the state of the wound. The in-situ biodegradation studies verified using cow-dung slurry, the degradability of the material with 25.3% weight loss within 30 days following first-order kinetics (R2 = 0.994), as a result of the attack of proteolytic enzymes on the amino acid units of SF, mitigating the concerns of medical wastes.

Internet service for wound area measurement using digital planimetry with adaptive calibration and image segmentation with deep convolutional neural networks

Uncontrolled diabetes leads to serious complications comparable to cancer. Infected foot ulcer causes a 5-year mortality of 50%. Proper treatment of foot wounds is essential, and wound area monitoring plays an important role in this area. In this article, we describe an automatic wound area measurement service that facilitates area measurement and the measurement result is based on adaptive calibration for larger accuracy at curved surfaces. Users need to take a digital picture of a wound and calibration markers and send them for analysis using an Internet page. The deep learning model based on convolutional neural networks (CNNs) was trained using 565 wound images and was used for image segmentation to identify the wound and calibration markers. The developed software calculates the wound area based on the number of pixels in the wound region and the calibration coefficient determined from distances between ticks at calibration markers. The result of the measurement is sent back to the user at the provided e-mail address. The median relative error of wound area measurement in the wound models was 1.21%. The efficacy of the CNN model was tested on 41 wounds and 73 wound models. The averaged values for the dice similarity coefficient, intersection over union, accuracy and specificity for wound identification were 90.9%, 83.9%, 99.3% and 99.6%, respectively. The service proved its high efficacy and can be used in wound area monitoring. The service may be used not only by health care specialists but also by patients. Thus, it is important tool for wound healing monitoring.

Preparation of carboxymethyl cellulose/polyvinyl alcohol wound dressing composite immobilized with anthocyanin extract for colorimetric monitoring of wound healing and prevention of wound infection

Novel aerogel-like wound dressing able to sense the healing progress was developed. Anthocyanins (Ac) have been reported as a significant pH-sensory extract with various biological activities. Herein, anthocyanins were extracted from red-cabbage (Brassica oleracea L. Var. capitata). The anthocyanin probe was integrated as a water-soluble direct dye at various concentrations into carboxymethyl cellulose/polyvinyl alcohol composite in the presence of potassium aluminum sulfate mordant. The generated composites were then freeze-dried to provide the corresponding aerogel-like smart wound dressing to function as an antibacterial and biochromic bulk presenting a comfort dressing biosensor to monitor the progress of a wound healing. Reducing the pH value of a wound mimicking fluid resulted in a hypsochromic shift from 592 to 446 nm. The halochromic activity of anthocyanin showed colorimetric changes from purple to pink. The colorimetric measurements of the prepared anthocyanin-containing aerogel-like diagnostic assay were explored by CIE Lab coordinates and UV–Vis absorption spectra. The effects of the anthocyanin content on the morphology, stiffness, air-permeability, and mechanical behavior of the aerogel-like wound dress were explored by various analytical methods. Both cytotoxicity and antibacterial activity of were investigated.

Advances in non-invasive biosensing measures to monitor wound healing progression

Impaired wound healing is a significant financial and medical burden. The synthesis and deposition of extracellular matrix (ECM) in a new wound is a dynamic process that is constantly changing and adapting to the biochemical and biomechanical signaling from the extracellular microenvironments of the wound. This drives either a regenerative or fibrotic and scar-forming healing outcome. Disruptions in ECM deposition, structure, and composition lead to impaired healing in diseased states, such as in diabetes. Valid measures of the principal determinants of successful ECM deposition and wound healing include lack of bacterial contamination, good tissue perfusion, and reduced mechanical injury and strain. These measures are used by wound-care providers to intervene upon the healing wound to steer healing toward a more functional phenotype with improved structural integrity and healing outcomes and to prevent adverse wound developments. In this review, we discuss bioengineering advances in 1) non-invasive detection of biologic and physiologic factors of the healing wound, 2) visualizing and modeling the ECM, and 3) computational tools that efficiently evaluate the complex data acquired from the wounds based on basic science, preclinical, translational and clinical studies, that would allow us to prognosticate healing outcomes and intervene effectively. We focus on bioelectronics and biologic interfaces of the sensors and actuators for real time biosensing and actuation of the tissues. We also discuss high-resolution, advanced imaging techniques, which go beyond traditional confocal and fluorescence microscopy to visualize microscopic details of the composition of the wound matrix, linearity of collagen, and live tracking of components within the wound microenvironment. Computational modeling of the wound matrix, including partial differential equation datasets as well as machine learning models that can serve as powerful tools for physicians to guide their decision-making process are discussed.

Implementing a mHealth-Based Patient and Nurse Educational Program to Reduce Wound Infection in Rural Philippines.

Background:Surgical site infection (SSI) is a prevalent but preventable complication in low-and-middle income countries (LMIC), with reported incidence varying from 8–30%. In 2018, the MEDIPINAS surgical mission to the Philippines observed a 28.8% rate of SSI despite adherence to WHO intraoperative protocols.The objective of this study was to introduce an educational program for wound care and early identification of wound infection. This program included provision of wound care materials and systematic protocol to ensure adequate and effective follow-up. Barriers to SSI prophylaxis in the Philippines include limited resources in regional hospitals and isolation of patients living in rural areas. The MEDIPINAS mission utilized mobile health software to connect with regional providers and to reinforce the wound care educational program introduced at discharge.Methods:The 2019 MEDIPINAS mission returned to the Philippines and operated on 187 patients in San Antonio de Padua Diocesan Hospital and Santa Maria Josefa Hospital. Before discharge, patients were individually consulted about maintaining the cleanliness of their surgical wound. Each patient was discharged with a wound care infographic and a kit to change dressings. In collaboration with regional care providers, we utilized a secure mobile health software to monitor wound healing 7 and 30 days following the operation.Results:Between the 2018 and 2019 surgical missions, we observed a decrease in SSI from 28.8% to 9.7%. Fourteen patients (7.5%) were lost to follow-up. Postoperative infection was diagnosed using photos provided by hospital-based nurses. Individuals with infections were treated with antibiotics and all but two SSI resolved after 30 days.Conclusions:Patient education, discharge with basic sanitary resources, and development of a mobile health-based follow-up infrastructure may contribute to significant reductions in SSI in LMICs. A limitation to implementation of such a program was integration of the mobile health software into the practice of local healthcare providers.

Oncogenic fusion of BCAR4 activates EGFR signaling and is sensitive to dual inhibition of EGFR/HER2.

We previously reported CD63-BCAR4 fusion as a novel oncogene that significantly enhanced cell migration and metastasis in lung cancer. To identify effective inhibitors of metastatic activity induced by BCAR4 fusion, we screened a drug library of 381 FDA-approved compounds. The effect of drugs on cell migration was evaluated by monitoring wound healing. Drugs that decreased the cellular mobility of fusion-overexpressing cells compared with that of control cells were selected as candidates. Library screening revealed that erlotinib, canertinib, and lapatinib demonstrated inhibitory effects on cell migration. Activation of the EGFR signaling pathway was detected after ectopic expression of CD63-BCAR4 in normal bronchial epithelial cells, as observed by the increased phosphorylation of tyrosine residues in the EGFR protein. We also confirmed increased levels of the phosphorylated EGFR protein in resected tumors from mice injected with CD63-BCAR4 overexpressing cells. Tyrosine kinase inhibitors (TKIs) of the EGFR family significantly inhibit the migration of BCAR4 fusion-overexpressing cells and induce apoptosis at high concentrations. Among the EGFR family TKIs, canertinib, a dual EGFR/HER2 inhibitor, showed the best inhibitory effect on the migration and viability of BCAR4 fusion-overexpressing cells. We examined the effect of canertinib in vivo using a mouse xenograft model. Oral administration of canertinib to xenografted mice reduced tumor growth induced by the CD63-BCAR4 fusion gene. In addition, canertinib treatment restored E-cadherin expression and reduced the expression of epithelial–mesenchymal transition regulatory factors such as Slug and Snail. Taken together, these results suggest that EGFR/HER2 inhibitors are potential therapeutic options for BCAR4 fusion-harboring lung cancer patients, even in the absence of EGFR mutations.

Biocompatible organic electrochemical transistor on polymeric scaffold for wound healing monitoring

Nowadays, no wearable device is available to continuously monitor the ulcer status. The literature reports a pH range between 6.5 and 9 for chronic or infected wounds. This study aims to produce an innovative scaffold able to monitoring wound pH and therefore ulcers healing. The scaffold was manufactured by spray, phase-inversion technique using a synthetic biocompatible material, poly(ether)urethane-polydimethylsiloxane (PEtU-PDMS). A bi-layer micro-fibrillar tubular scaffold was obtained using: (a) 2% polymer solution and H2O as non-solvent; (b) 0.2% and H2O. Poly(3,4‐ethylenedioxythiophene):poly(styrene sulfonate) (PEDOT:PSS) is a biocompatible conductive polymer used as active material in a biosensor due to high sensitivity to positive ions in liquid environment allowing to determine ions concentration in easy and stable way. The biocompatible scaffold was functionalized by inkjet-printing of a PEDOT:PSS to develop organic electrochemical transistor (OECT) architecture. The electrochemical device was connected with electric contacts to create a channel and a gate electrode to control the modulation changes of the sensor. The morphological analysis of PEtU-PDMS scaffold surfaces was performed using a stereo-microscope after Sudan Black B staining while the PEDOT:PSS pattern by SEM microscopy. The device functionality was proved on human serum at different pH (between four and ten). The morphological analysis showed a dense, non-porous surface obtained with the 2% solution, while a porous surface was obtained with the 0.2% solution where the PEDOT:PSS was positioned. This feature, maintained after lyophilization and re-hydratation, enables a thin PEDOT:PSS film deposition in a continuous and homogeneus pattern. The characteristic of the device was tested showing the sensitivity to saline concentration and the effective functionality of the device. Moreover, the device response shows a dependence to pH variations as well as the transconductance. Obtained data suggest that the proposed sensorised scaffold could be used as a wearable detector for wound healing monitoring in patients affected by chronic lesions.

Wound tissue segmentation by computerised image analysis of clinical pressure injury photographs: a pilot study.

Wound tissues can provide ample information about the wound development and healing process. However, the manual identification and measurement of wound tissue types is time-consuming and challenging due to the complexities of pressure injuries (PI). This study aims to develop an image analysis algorithm to automatically identify and differentiate wound tissue types from PI wound beds. This was a cross-sectional algorithm development study. PI photographs were obtained from a western Pennsylvania hospital. We used our previously developed wound bed segmentation tool to identify PI wound beds. We then used the k-means clustering method to classify the subzones on the wound beds. Finally, the support vector machine classifier was used to identify the classified subzones to certain types of wound tissue. An image analysis algorithm was developed, using 64 selected PI photographs, to automatically identify different wound tissues for PIs. Validation of the wound tissue identification of the PIs by image analysis algorithm demonstrated that our image analysis algorithm is a reliable and objective approach to monitoring wound healing progress through clinical PI photographs, and offers new insight into PI evaluation and documentation. The authors have no conflicts of interest to declare.

Chlorhexidine gluconate lavage during total joint arthroplasty may improve wound healing compared to dilute betadine

PurposeIntraoperative wound irrigation prior to closure during total joint arthroplasty (TJA) is an essential component of preventing infections and limiting health care system costs. While studies have shown the efficacy of dilute betadine in reducing infection risk, there remains concerns over its safety profile and theoretical inactivation by blood and serum. This study aims to compare infection and wound complications between chlorhexidine gluconate (CHG) and betadine lavage during TJA.MethodsAll primary TJA between 2019–2021 were analyzed at a single institution, and periprosthetic joint infection (PJI), wound drainage, 30 and 90-day emergency room (ER) readmission due to wound complications, aseptic loosening, and revision surgery rate were compared between patients undergoing intraoperative CHG versus betadine lavage prior to closure. Baseline demographics were controlled, and multivariate logistic regression was performed to compare complication rates.ResultsA total of 410 TJA, including 160 hip and 250 knee arthroplasties were included. Compared to the dilute betadine cohort, all TJA patients undergoing CHG lavage had a statistically significant lower 30 and 90-day emergency room readmission rate due to wound complications. Both hip and knee arthroplasty patients with CHG had a statistically significant lower rate of postoperative superficial drainage and dressing saturation at clinic follow-up, but only knee arthroplasty patients had significant decreased readmission rate for incisional wound vacuum placement and close inpatient monitoring of wound healing. Among all TJA, there was no significant association in the rate of PJI requiring return to the OR between groups.ConclusionsAlthough betadine is cost-effective and has been shown to reduce PJI rates, there remains concerns in the literature over soft tissue toxicity and wound healing. This study suggests CHG may be as efficacious as dilute betadine in preventing PJI while also decreasing the risk of superficial drainage and wound complications needing unplanned ER visits during the acute postoperative period.

Conductive hydrogel dressings based on cascade reactions with photothermal effect for monitoring and treatment of diabetic wounds

Diabetic chronic wounds have serious threats to public health, posing enormous challenges and financial burdens around the world. Monitoring and treatment of chronic diabetic wounds is an urgent issue that must be addressed right now. Herein, conductive hydrogels with multifunctionality were proposed and created by incorporating polydopamine (PDA) nanoparticles, glucose oxidase (GOx) and catalase (CAT) into polydopamine/acrylamide (PDA/AM) hydrogels to monitor and repair diabetic chronic wounds. Under the irradiation of 808 nm Near-infrared (NIR), PDA nanoparticles encapsulated in PDA/AM hydrogels possessed good antibacterial capabilities (99.99%). The introduction of GOx not only lowered hyperglycemia to normal level (5.1 mmol/L), but it also improved wound hemostasis adhesion (38 kPa). Hydrogen peroxide (H2O2) generated oxygen (O2, 18 mg/mL) via a cascade reaction under the catalysis of CAT, which could accelerate angiogenesis and stimulate cell migration and proliferation. The addition of ions enabled the hydrogel to have excellent electrical conductivity, allowing for precise wound healing monitoring. Conductive hydrogels with the multifunction of hemostasis, antibacterial, hyperglycemia manipulation, and O2 generation show promise in diabetic foot wound repair and wound monitoring.

Reproducibility of high-resolution laser speckle contrast imaging to assess cutaneous microcirculation for wound healing monitoring in mice.

Laser speckle contrast imaging (LSCI) combines an excellent spatial and temporal resolution, with excellent reproducibility in humans. Recently, high-resolution LSCI (LSCI-HR), coupled or not with oximetry, have been marketed. They are promising approaches to assess wound healing, especially in rodents. However, their reproducibility and performance against a reference technique remain unknown. Healthy skin perfusion was evaluated at day 0 and repeated at day 2, using LSCI-HR, high-resolution LSCI with oximetry by reflectance spectrometry (LSCI-OX), compared with laser Doppler imaging (LDI) as a reference. In a second experiment, cutaneous perfusion was measured daily during 8days after wounding at two different sites. The reproducibility of haemoglobin oxygenation with LSCI-OX was also assessed in the two experiments. Reproducibility was expressed as within-subject coefficients of variation (CV, in %). The inter-day reproducibility of healthy skin perfusion was better when assessed with LSCI-HR and LSCI-OX, compared to LDI (CVs between 12 and 17% and between 26 and 29%, respectively). Inter-site reproducibility of perfusion during wound healing was also better with LSCI-HR compared to LDI (CV=12% and 23%, respectively). Finally, we observed a good, positive correlation between perfusion measured with LDI and LSCI-HR on the periulcer area (average r=0.77±0.24). Recently developed high-resolution LSCI devices provide good reproducibility to assess healthy and wounded skin perfusion in mice. However, the reproducibility of haemoglobin oxygenation is poor.

Digital photography in the evaluation and management of female patients with congenital adrenal hyperplasia: A standardized protocol for quality improvement

Digital photography can be securely stored in the medical record and enhance documentation of physical exam findings and monitor wound healing. A standardized protocol that respects the dignity of the patient and maintains the fidelity of objective documentation is needed for patients with differences in sexual development (DSD) and congenital adrenal hyperplasia (CAH). The purpose of this study was to evaluate the feasibility, acceptability, and applications of a HIPAA-compliant digital photography protocol in the care of female patients with CAH. A protocol for standardized digital imaging including consent, permission, data capture, and storage in the electronic medical record (EMR) was implemented. Patients undergoing physical examination during multidisciplinary CAH clinic visits, preoperative evaluation, and postoperative follow-up from October 2020 through May 2021 were included. Male patients with CAH, patients with clitoromegaly or urogenital sinus not from CAH, and patients seen through telehealth were excluded. Consent was obtained from caregivers and permission from patients. Images of the exam were taken during clinic visits or at the time of surgery with no identifying features included. Images were directly uploaded into the patient's chart in the HIPAA-protected EMR separate from other clinical documentation and not stored on personal devices. There were 17 patients with CAH seen with median age 6 years (range 2 weeks-18 years). There was a median of 3 photos per patient during the study period with cooperation from both the patient and their caregiver. Amongst the patients seen, 6 patients underwent reconstruction with a median of 10 photos per patient. Images were available and used for preoperative planning and counseling. Patients with previous images did not require repeat examinations and were subjected to fewer genital examinations. Fewer providers were present during exams. Images taken by providers and caregivers during the postoperative period were used to monitor wound healing and surgical outcomes. Protocol implementation improved patient care by reducing the number of exams and number of providers present, enhancing clinical documentation, and providing a means of tracking the physical exam over time. This was in concordance with guidelines for limiting exams for patients with DSD and CAH. Implementation of best practices for medical photography was important in respecting patient dignity and confidentiality. Implementation of standardized digital photography was feasible and acceptable to patients and caregivers. Digital images reduced the need for repeat physical examination and provided a visual means of enhancing clinical documentation.

Monitoring Wound Healing with Topically Applied Optical NanoFlare mRNA Nanosensors.

An effective wound management strategy needs accurate assessment of wound status throughout the whole healing process. This can be achieved by examining molecular biomarkers including proteins, DNAs, and RNAs. However, existing methods for quantifying these biomarkers such as immunohistochemistry and quantitative polymerase chain reaction are usually laborious, resource‐intensive, and disruptive. This article reports the development and utilization of mRNA nanosensors (i.e., NanoFlare) that are topically applied on cutaneous wounds to reveal the healing status through targeted and semi‐quantitative examination of the mRNA biomarkers in skin cells. In 2D and 3D in vitro models, the efficacy and efficiency of these nanosensors are demonstrated in revealing the dynamic changes of mRNA biomarkers for different stages of wound development. In mouse models, this platform permits the tracking and identification of wound healing stages and a normal and diabetic wound healing process by wound healing index in real time.

Photoacoustic microscopy of vascular adaptation and tissue oxygen metabolism during cutaneous wound healing.

Cutaneous wounds affect millions of people every year. Vascularization and blood oxygen delivery are critical bottlenecks in wound healing, and understanding the spatiotemporal dynamics of these processes may lead to more effective therapeutic strategies to accelerate wound healing. In this work, we applied multi-parametric photoacoustic microscopy (PAM) to study vascular adaptation and the associated changes in blood oxygen delivery and tissue oxygen metabolism throughout the hemostasis, inflammatory, proliferation, and early remodeling phases of wound healing in mice with skin puncture wounds. Multifaceted changes in the vascular structure, function, and tissue oxygen metabolism were observed during the 14-day monitoring of wound healing. On the entire wound area, significant elevations of the arterial blood flow and tissue oxygen metabolism were observed right after wounding and remained well above the baseline over the 14-day period. On the healing front, biphasic changes in the vascular density and blood flow were observed, both of which peaked on day 1, remained elevated in the first week, and returned to the baselines by day 14. Along with the wound closure and thickening, tissue oxygen metabolism in the healing front remained elevated even after structural and functional changes in the vasculature were stabilized. On the newly formed tissue, significantly higher blood oxygenation, flow, and tissue metabolism were observed compared to those before wounding. Blood oxygenation and flow in the new tissue appeared to be independent of when it was formed, but instead showed noticeable dependence on the phase of wound healing. This PAM study provides new insights into the structural, functional, and metabolic changes associated with vascular adaptation during wound healing and suggests that the timing and target of vascular treatments for wound healing may affect the outcomes.