Determination Of Adequate Debridement Of Burn Wounds Via Laser Speckle Imaging
Randolph Stone, II, David Larson, John Wall, Kyle Florell, Hannah Dillon, Christine Kowalczewski, Shanmugasundaram Natesan, Robert Christy.
US Army Institute of Surgical Research, Fort Sam Houston, TX, USA.
Background: The current standard of care for burn wound management involves removal of necrotic tissue to a bleeding wound bed then application of a skin graft depending on the depth of injury. However, the debridement procedure is difficult, time consuming, and can result in graft failure and hypertrophic scarring if performed inadequately. The purpose of this study was to determine if laser speckle imaging (LSI) could be utilized to image the debrided wound beds prior to grafting to determine if adequate debridement was performed. Methods: Deep partial and full thickness 5x5 cm burn wounds were created on the dorsum of six anesthetized Yorkshire pigs using appropriate pain control methods. After 4 days, the necrotic eschar was debrided via a dermatome to three depths (0.030”, 0.060”, 0.090”), a meshed split thickness skin graft was applied, and graft success (defined as >70% graft take) monitored for 14 days. LSI, which measures blood flow, was captured for all wounds pre-burn, post-burn, pre-debridement, and post-debridement. Results: Approximately 65% of wounds with the least debridement amount resulted in graft failure. LSI indicated no differences immediately post-burn but measured significant differences pre-debridement comparing burn depths. After combining all wounds into either graft success vs. failure, LSI detected higher blood flow in post-debrided wounds (0.770 vs. 0.433, respectively, p<0.001). Conclusions: This study confirmed the clinical situation of inadequate debridement as a contributor of graft failure. More importantly, LSI was able to differentiate between the wounds that were adequately debrided and those where necrotic tissue remained; thereby, providing clinicians with a non-invasive technique that could help determine when to graft.
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