Preclosure spectroscopic differences between healed and dehisced traumatic wounds

• Type of Material: Article
• Authors: Jason S. Radowsky, Uniformed Services University of the Health Sciences; Romon Neely, Uniformed Services University of the Health Sciences; Jonathan A. Forsberg, Johns Hopkins University; Felipe A. Lisboa, Uniformed Services University of the Health Sciences; Christopher J Dente, Emory University; Eric A. Elster, Uniformed Services University of the Health Sciences; Nicole J. Crane, Uniformed Services University of the Health Sciences
• Language: English
• Date: 2018-09-27
• Publisher: Public Library of Science
• Publication Version: Final Published Version
• Copyright Statement: © 2018 Public Library of Science. All rights reserved.
• License: Creative Commons Creative Commons CC0 1.0 Universal
• Final Published Version (URL): http://dx.doi.org/10.1371/journal.pone.0204453
• Title of Journal or Parent Work: PLoS ONE
• ISSN: 1932-6203
• Volume: 13
• Issue: 9
• Start Page: e0204453
• End Page: e0204453
• Grant/Funding Information: Additionally, this work was supported/funded by work unit numbers 602115HP.3720.001.A1015 and 604115HP.4640.001.A1268.; The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Go to: Footnotes; Funding Support includes USAMRAA Peer Reviewed Orthopaedic Research Program award W81XWH-10-2-0162 and USAMRAA award W81XWH-13-2-0039.; Research activities leading to the development of this manuscript were funded by the Department of Defense’s Defense Health Program – Joint Program Committee 6 / Combat Casualty Care (USUHS HT9404-13-1-0032 and HU0001-15-2-0001).
• Keywords: TISSUE OXYGENATION; Science & Technology; EXPRESSION; Multidisciplinary Sciences; WAR; REFLECTANCE; MODEL; INFECTION; FAILURE; Science & Technology - Other Topics; IMAGING TECHNOLOGIES; BIOMARKERS; ENHANCEMENT
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Background The complexity and severity of traumatic wounds in military and civilian trauma demands improved wound assessment, before, during, and after treatment. Here, we explore the potential of 3 charge-coupled device (3CCD) imaging values to distinguish between traumatic wounds that heal following closure and those that fail. Previous studies demonstrate that normalized 3CCD imaging values exhibit a high correlation with oxygen saturation and allow for comparison of values between diverse clinical settings, including utilizing different equipment and lighting. Methods We screened 119 patients at Walter Reed National Military Medical Center and at Grady Memorial Hospital with at least one traumatic extremity wound of 75 cm2. We collected images of each wound during each débridement surgery for a total of 66 patients. An inhouse written computer application selected a region of interest in the images, separated the pixel color values, calculated relative values, and normalized them. We followed patients until the enrolled wounds were surgically closed, quantifying the number of wounds that dehisced (defined as wound failure or infection requiring return to the operating room after closure) or healed. Results Wound failure occurred in 20% (19 of 96) of traumatic wounds. Normalized intensity values for patients with wounds that healed successfully were, on average, significantly different from values for patients with wounds that failed (p ≤ 0.05). Simple thresholding models and partial least squares discriminant analysis models performed poorly. However, a hierarchical cluster analysis model created with 17 variables including 3CCD data, wound surface area, and time from injury predicts wound failure with 76.9% sensitivity, 76.5% specificity, 76.6% accuracy, and a diagnostic odds ratio of 10.8 (95% confidence interval: 2.6± 45.9). Conclusions Imaging using 3CCD technology may provide a non-invasive and cost-effective method of aiding surgeons in deciding if wounds are ready for closure and could potentially decrease the number of required débridements and hospital days. The process may be automated to provide real-time feedback in the operating room and clinic. The low cost and small size of the cameras makes this technology attractive for austere and shipboard environments where space and weight are at a premium.