A systematic review of the evolution of laser Doppler techniques in burn depth assessment

Manaf Khatib, Shehab Jabir, Edmund Fitzgerald O'Connor, Bruce Philp, Manaf Khatib, Shehab Jabir, Edmund Fitzgerald O'Connor, Bruce Philp

Abstract

Aims. The introduction of laser Doppler (LD) techniques to assess burn depth has revolutionized the treatment of burns of indeterminate depth. This paper will systematically review studies related to these two techniques and trace their evolution. At the same time we hope to highlight current controversies and areas where further research is necessary with regard to LD imaging (LDI) techniques. Methods. A systematic search for relevant literature was carried out on PubMed, Medline, EMBASE, and Google Scholar. Key search terms included the following: "Laser Doppler imaging," "laser Doppler flow," and "burn depth." Results. A total of 53 studies were identified. Twenty-six studies which met the inclusion/exclusion criteria were included in the review. Conclusions. The numerous advantages of LDI over those of LD flowmetry have resulted in the former technique superseding the latter one. Despite the presence of alternative burn depth assessment techniques, LDI remains the most favoured. Various newer LDI machines with increasingly sophisticated methods of assessing burn depth have been introduced throughout the years. However, factors such as cost effectiveness, scanning of topographically inconsistent areas of the body, and skewing of results due to tattoos, peripheral vascular disease, and anaemia continue to be sighted as obstacles to LDI which require further research.

Figures

Figure 1
Figure 1
The Moor LDI system used by Pape et al. in their study and in our burns unit at St. Andrews Centre for Plastic Surgery and Burns.
Figure 2
Figure 2
Appearance of a burn wound using the Aimago EasyLDI technology. It enables visualization of the microcirculation and the blood flow in small vessels with the increasingly red regions indicating greater blood flow.

References

    1. Cubison TCS, Pape SA, Parkhouse N. Evidence for the link between healing time and the development of hypertrophic scars (HTS) in paediatric burns due to scald injury. Burns. 2006;32(8):992–999.
    1. Monstrey S, Hoeksema H, Verbelen J, Pirayesh A, Blondeel P. Assessment of burn depth and burn wound healing potential. Burns. 2008;34(6):761–769.
    1. Stern MD. In vivo evaluation of microcirculation by coherent light scattering. Nature. 1975;254(5495):56–58.
    1. Green M, Holloway GA, Heimbach DM. Laser Doppler monitoring of microcirculatory changes in acute burn wounds. Journal of Burn Care & Rehabilitation. 1988;9(1):57–62.
    1. O'Reilly T, Spence R, Taylor R, Scheulen J. Laser Doppler flowmetry evaluation of burn wound depth. Journal of Burn Care & Rehabilitation. 1989;10(1):1–6.
    1. Chatterjee JS. A critical evaluation of the clinimetrics of laser doppler as a method of burn assessment in clinical practice. Journal of Burn Care and Research. 2006;27(2):123–130.
    1. Waxman K, Lefcourt N, Achauer B. Heated laser doppler flow measurements to determine depth of burn injury. The American Journal of Surgery. 1989;157(6):541–543.
    1. Atiles L, Mileski W, Purdue G, Hunt J, Baxter C. Laser Doppler flowmetry in burn wounds. Journal of Burn Care & Rehabilitation. 1995;16(4):388–393.
    1. Niazi ZBM, Essex TJH, Papini R, Scott D, McLean NR, Black MJM. New laser doppler scanner, a valuable adjunct in burn depth assessment. Burns. 1993;19(6):485–489.
    1. Park D-H, Hwang J-W, Jang K-S, Han D-G, Ahn K-Y, Baik B-S. Use of laser Doppler flowmetry for estimation of the depth of burns. Plastic & Reconstructive Surgery. 1998;101(6):1516–1523.
    1. Banwell PE, Tyler MPH, Watts AMI, N Roberts AH, McGrouther DA. Burn depth estimation: use of laser Doppler flowmetry. Plastic & Reconstructive Surgery. 1999;103(1):334–335.
    1. Pape SA, Skouras CA, Byrne PO. An audit of the use of laser Doppler imaging (LDI) in the assessment of burns of intermediate depth. Burns. 2001;27(3):233–239.
    1. Kloppenberg FWH, Beerthuizen GIJM, ten Duis HJ. Perfusion of burn wounds assessed by Laser Doppler Imaging is related to burn depth and healing time. Burns. 2001;27(4):359–363.
    1. Holland AJA, Martin HCO, Cass DT. Laser Doppler imaging prediction of burn wound outcome in children. Burns. 2002;28(1):11–17.
    1. Jeng JC, Bridgeman A, Shivnan L, et al. Laser Doppler imaging determines need for excision and grafting in advance of clinical judgment: a prospective blinded trial. Burns. 2003;29(7):665–670.
    1. Mileski WJ, Atiles L, Purdue G, et al. Serial measurements increase the accuracy of laser Doppler assessment of burn wounds. Journal of Burn Care & Rehabilitation. 2003;24(4):187–191.
    1. Riordan CL, McDonough M, Davidson JM, et al. Noncontact laser Doppler imaging in burn depth analysis of the extremities. Journal of Burn Care & Rehabilitation. 2003;24(4):177–186.
    1. La Hei ER, Holland AJA, Martin HCO. Laser Doppler Imaging of paediatric burns: burn wound outcome can be predicted independent of clinical examination. Burns. 2006;32(5):550–553.
    1. McGill DJ, Sørensen K, MacKay IR, Taggart I, Watson SB. Assessment of burn depth: a prospective, blinded comparison of laser Doppler imaging and videomicroscopy. Burns. 2007;33(7):833–842.
    1. Hoeksema H, van de Sijpe K, Tondu T, et al. Accuracy of early burn depth assessment by laser Doppler imaging on different days post burn. Burns. 2009;35(1):36–45.
    1. Cho JK, Moon DJ, Kim SG, Lee HG, Chung SP, Yoon CJ. Relationship between healing time and mean perfusion units of laser Doppler imaging (LDI) in pediatric burns. Burns. 2009;35(6):818–823.
    1. Mill J, Cuttle L, Harkin DG, Kravchuk O, Kimble RM. Laser Doppler imaging in a paediatric burns population. Burns. 2009;35(6):824–831.
    1. Kim LHC, Ward D, Lam L, Holland AJA. The impact of laser doppler imaging on time to grafting decisions in pediatric burns. Journal of Burn Care and Research. 2010;31(2):328–332.
    1. Merz KM, Pfau M, Blumenstock G, Tenenhaus M, Schaller HE, Rennekampff HO. Cutaneous microcirculatory assessment of the burn wound is associated with depth of injury and predicts healing time. Burns. 2010;36(4):477–482.
    1. Nguyen K, Ward D, Lam L, Holland AJA. Laser Doppler Imaging prediction of burn wound outcome in children: is it possible before 48 h? Burns. 2010;36(6):793–798.
    1. Lindahl F, Tesselaar E, Sjöberg F. Assessing paediatric scald injuries using laser speckle contrast imaging. Burns. 2013;39(4):662–666.
    1. Menon S, Ward D, Harvey JG, Hei EL, Holland AJA. Friction burns in children: does laser doppler imaging have a role? Journal of Burn Care and Research. 2012;33(6):736–740.
    1. Pape SA, Baker RD, Wilson D, et al. Burn wound healing time assessed by laser Doppler imaging (LDI). Part 1: derivation of a dedicated colour code for image interpretation. Burns. 2012;38(2):187–194.
    1. Park YS, Choi YH, Lee HS, et al. The impact of laser Doppler imaging on the early decision-making process for surgical intervention in adults with indeterminate burns. Burns. 2013;39(4):655–661.
    1. Stewart TL, Ball B, Schembri PJ, et al. The use of laser doppler imaging as a predictor of burn depth and hypertrophic scar postburn injury. Journal of Burn Care and Research. 2012;33(6):764–771.
    1. Lang K, Boyd L. The use of Fluorescein to determine the adequacy of ciculation. Medical Clinics of North America. 1942;26, article 943
    1. Dingwall J. A clinical test for differentiating second from third degree burns. Annals of Surgery. 1943;118(3):427–429.
    1. Jackson DM. The diagnosis of the depth of burning. British Journal of Surgery. 1953;40(164):588–596.
    1. Jaskille AD, Shupp JW, Jordan MH, Jeng JC. Critical review of burn depth assessment techniques: Part I. historical review. Journal of Burn Care and Research. 2009;30(6):937–947.
    1. Silverman DG, LaRossa DD, Barlow CH, Bering TG, Popky LM, Smith TC. Quantification of tissue fluorescein delivery and prediction of flap viability with the fiberoptic dermofluorometer. Plastic and Reconstructive Surgery. 1980;66(4):545–553.
    1. Graham BH, Walton RL, Elings VB, Lewis FR. Surface quantification of injected fluorescein as a predictor of flap viability. Plastic and Reconstructive Surgery. 1983;71(6):826–833.
    1. Denneny JC, III, Weisman RA, Silverman DG. Monitoring free flap perfusion by serial fluorometry. Otolaryngology: Head and Neck Surgery. 1983;91(4):372–376.
    1. Gatti JE, LaRossa D, Silverman DG, Hartford CE. Evaluation of the burn wound with perfusion fluorometry. Journal of Trauma. 1983;23(3):202–206.
    1. Black KS, Hewitt CW, Miller DM, et al. Burn depth evaluation with fluorometry: Is it really definitive? Journal of Burn Care & Rehabilitation. 1986;7(4):313–317.
    1. Green HA, Bua D, Anderson RR, Nishioka NS. Burn depth estimation using indocyanine green fluorescence. Archives of Dermatology. 1992;128(1):43–49.
    1. Still JM, Law EJ, Klavuhn KG, Island TC, Holtz JZ. Diagnosis of burn depth using laser-induced indocyanine green fluorescence: a preliminary clinical trial. Burns. 2001;27(4):364–371.
    1. Ishihara H, Otomo N, Suzuki A, Takamura K, Tsubo T, Matsuki A. Detection of capillary protein leakage by glucose and indocyanine green dilutions during the early post-burn period. Burns. 1998;24(6):525–531.
    1. Benya R, Quintana J, Brundage B. Adverse reactions to indocyanine green: a case report and a review of the literature. Catheterization and Cardiovascular Diagnosis. 1989;17(4):231–233.
    1. Kaiser M, Yafi A, Cinat M, Choi B, Durkin AJ. Noninvasive assessment of burn wound severity using optical technology: a review of current and future modalities. Burns. 2011;37(3):377–386.
    1. Anselmo V, Zawacki B. Infrared photography as a diagnostic tool for the burn ward. Proceeding Society of Photo-Optical Instrumentation Engineers. 1973;8:p. 181.
    1. Tehrani H, Moncrieff M, Philp B, Dziewulski P. Spectrophotometric intracutaneous analysis: a novel imaging technique in the assessment of acute burn depth. Annals of Plastic Surgery. 2008;61(4):437–440.
    1. Thorne FL, Georgiade NG, Mladick R. The use of thermography in determining viability of pedicle flaps. Archives of Surgery. 1969;99(1):97–99.
    1. Mladick R, Georgiade N, Thorne F. A clinical evaluation of the use of thermography in determining degree of burn injury. Plastic and Reconstructive Surgery. 1966;38(6):512–518.
    1. Watson AC, Vasilescu C. Thermography in plastic surgery. Journal of the Royal College of Surgeons of Edinburgh. 1972;17(4):247–252.
    1. Hackett MEJ. The use of thermography in the assessment of depth of burn and blood supply of flaps, with preliminary reports on its use in Dupuytren's contracture and treatment of varicose ulcers. British Journal of Plastic Surgery. 1974;27(4):311–317.
    1. Anselmo VJ, Zawacki BE. Effect of evaporative surface cooling on thermographic assessment of burn depth. Radiology. 1977;123(2):331–332.
    1. Renkielska A, Nowakowski A, Kaczmarek M, et al. Static thermography revisited—an adjunct method for determining the depth of the burn injury. Burns. 2005;31(6):768–775.
    1. Renkielska A, Nowakowski A, Kaczmarek M, Ruminski J. Burn depths evaluation based on active dynamic IR thermal imaging-A preliminary study. Burns. 2006;32(7):867–875.
    1. Hardwicke J, Thomson R, Bamford A, Moiemen N. A pilot evaluation study of high resolution digital thermal imaging in the assessment of burn depth. Burns. 2013;39(1):76–81.
    1. Altintas AA, Guggenheim M, Altintas MA, Amini P, Stasch T, Spilker G. To heal or not to heal: predictive value of in vivo reflectance-mode confocal microscopy in assessing healing course of human burn wounds. Journal of Burn Care and Research. 2009;30(6):1007–1012.
    1. Mihara K, Shindo H, Ohtani M, et al. Early depth assessment of local burns by videomicroscopy: 24 h after injury is a critical time point. Burns. 2011;37(6):986–993.
    1. Mihara K, Shindo H, Mihara H, Ohtani M, Nagasaki K, Katoh N. Early depth assessment of local burns by videomicroscopy: a novel proposed classification. Burns. 2012;38(3):371–377.
    1. Goans RE, Cantrell JH, Jr., Meyers FB. Ultrasonic pulse echo determination of thermal injury in deep dermal burns. Medical Physics. 1977;4(3):259–263.
    1. Kalus A, Aindow J, Caulfield M. Application of ultrasound in assessing burn depth. The Lancet. 1979;414:188–189.
    1. Cantrell JH., Jr. Can ultrasound assist an experienced surgeon in estimating burn depth? Journal of Trauma. 1984;24(9):S64–S70.
    1. Wachtel TL, Leopold GR, Frank HA, Frank DH. B-mode ultrasonic echo determination of depth of thermal injury. Burns. 1986;12(6):432–437.
    1. Iraniha S, Cinat ME, VanderKam VM, et al. Determination of burn depth with noncontact ultrasonography. Journal of Burn Care and Rehabilitation. 2000;21(4):333–338.
    1. McGill DJ, Taggart I. Tattoos: a confounding issue in laser Doppler imaging of burn depth. Burns. 2005;31(5):657–659.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다