- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04233307
Wound Perfusion in High Risk Surgical Incisions
Non-invasive Assessment of Perfusion and the Risk of Wound Complication in High Risk Surgical Incisions
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Patients with qualifying injuries will be identified at the time of injury. There will be no deviation from standard of care for these patients outside of the acquisition of the FLIR image. Standard emergent management of these injuries including but not limited to reduction, immobilization, and acquisition of advanced imaging will take place. Pre-operative discussion of the risks and benefits of surgical management will occur and informed consent obtained.
Propofol is a commonly used anesthetic agent. However, propofol is also a vasodilating agent, which acts by blocking sympathetic tone. Limited worked has been done to evaluate the effects of propofol administration on the FLIR imaging data acquisition. A single study used FLIR to look at tissue perfusion after propofol infusion in children. In this study, the primary concern was whether infrared imaging could replace or augment, serial blood pressure and heart rate measurements, or other invasive monitoring measurements in patients undergoing general anesthesia with the use of vasodilatory agents, such as propofol. The authors' goal was to "assess the ability of the thermal imager to trend heat loss that registers as skin temperature from propofol-mediated vasodilation and study reversibility as propofol levels drop and vascular tone returns." This leaves a void regarding surgeons' understanding of the optimal timing of FLIR perfusion assessment and the reliability of measurements obtained pre and post propofol infusion.
In order to better understand the effects of propofol and determine the optimal time for determining perfusion with the FLIR camera, the investigators will take a first reading in the pre-operative holding area, prior to the administration of any propofol or other vaso-active agent (as described below). Once in the operating room, after the induction of anesthesia but prior to application of any topical cleansing or cooling products to the skin, the participant will be transferred to the operating room table and placed on a clean, white sheet and blankets will be removed from both lower extremities. The planned surgical incision(s) to be used will be drawn on the skin by the most senior surgeon. Next, a clinical photo and a FLIR image will be obtained at 90 degrees to the skin, and 1 meter from the surface of the skin at the site of each planned incision. One researcher has successfully used a protocol of taking images at perpendicular to the skin and 1 meter distance and demonstrated that deviation of as much as 20 degrees from the perpendicular and 0.5m of distance has negligible effect on readings. A set of control photos, identical to the ones obtained on the injured extremity will be obtained on the contralateral, non-injured extremity. A physician who is part of the surgical team who is trained in the use of the FLIR camera will obtain the images. At the time of image acquisition, results of the wrinkle test at each incision, patient body temperature, room temperature and humidity will be recorded. Analysis of the FLIR images will involve averaging the tissue perfusion in a box drawn with 1 cm borders around the planned incision site as well as the entire area imaged. This will be compared to the control, the contralateral uninjured extremity.
Participants will receive standard operative management of these injuries with standard of care post-operative management.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Barbara Steverson, MHA
- Phone Number: 8132532068
- Email: bsteverson@floridaortho.com
Study Contact Backup
- Name: Randi Alexander, MPH
- Phone Number: 8132532068
- Email: ralexander@floridaortho.com
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Skeletally mature patients, with talus, calcaneus, tibial plafond, trimalleolar ankle fracture-dislocations, lisfranc, or tibial plateau fractures who are indicated for surgical management in the form of open reduction and internal fixation or external fixation.
Exclusion Criteria:
- Pathologic Fracture
- Previous open surgery in the operative field
- Prisoners
- Systemic skin disorder affecting the surgical field
- Vascular Injury involving vessel that supplies the surgical field
- Bilateral qualifying lower extremity injuries
- Homeless
- Those unable to follow up through the study period
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Diagnostic
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Other: Wound photographs
Telethermographic photographs of fracture wound and contralateral limb before and after propofol infusion.
|
Infrared digital thermography photographs of fracture wound and contralateral limb before and after propofol infusion.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Soft tissue healing
Time Frame: 2 weeks post-operative
|
The number of patients with the expected level of incision healing appropriate to the time frame per Clinician judgement
|
2 weeks post-operative
|
Soft tissue healing
Time Frame: 6 weeks post-operative
|
The number of patients with the expected level of incision healing appropriate to the time frame per Clinician judgement
|
6 weeks post-operative
|
Soft tissue healing
Time Frame: 3 months post-operative
|
The number of patients with the expected level of incision healing appropriate to the time frame per Clinician judgement
|
3 months post-operative
|
Soft tissue healing
Time Frame: 6 months post-operative
|
The number of patients with the expected level of incision healing appropriate to the time frame per Clinician judgement
|
6 months post-operative
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Additional wound care intervention needed
Time Frame: within the 2 week post-operative period
|
The number of participants requiring topical wound care, oral antibiotics, repeat surgical debridement, soft tissue coverage procedure or amputation required
|
within the 2 week post-operative period
|
Additional wound care intervention needed
Time Frame: within the 6 week post-operative period
|
The number of participants requiring topical wound care, oral antibiotics, repeat surgical debridement, soft tissue coverage procedure or amputation required
|
within the 6 week post-operative period
|
Additional wound care intervention needed
Time Frame: within the 3 month post-operative period
|
The number of participants requiring topical wound care, oral antibiotics, repeat surgical debridement, soft tissue coverage procedure or amputation required
|
within the 3 month post-operative period
|
Additional wound care intervention needed
Time Frame: within the 6 month post-operative period
|
The number of participants requiring topical wound care, oral antibiotics, repeat surgical debridement, soft tissue coverage procedure or amputation required
|
within the 6 month post-operative period
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Hassan Mir, MD, Florida Orthopaedic Institute
Study record dates
Study Major Dates
Study Start (Anticipated)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- USF000305
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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