(PI-050) Thermal Assessment of the Post-transplant and Immunosuppressed Surgical Incision to Provide Early Interventions for Non-visible Pathophysiologic Changes Below the Skin

Deanna Vargo, RN BSN CWS FACCWS CWOCN – Clinical Specialist, Clinical, n/a

Introduction: Liver transplant patients are at risk for surgical site infections and abscesses.¹

Poor wound healing is a common side effect of high-dose steroids. Posttransplant immunosuppression is necessary to prevent rejection of the donor organ and must be balanced to maintain immunologic functions (i.e., prevention or recurrence of infection).¹

Dehiscence can occur at any time after surgery and can occur without warning.²

Methods: The Wound Care staff utilizes Long-Wave Infrared Thermography (LWIT) to support incisional assessments.

LWIT produces a digital and a mirroring thermal image where colors represent temperatures. Thermal measurements are compared between the incisional and adjacent tissue, identifying pathophysiologic changes that are not visible. Abnormal warm temperatures may indicate inflammation or infection, and cool temperatures may indicate decreased perfusion or fluid collection.

The wound care team communicates abnormal thermal findings, such as at risk of dehiscence, which may appear as (a) no initial inflammation or signs of inflammation beyond the time expected for routine healing, (b) a cool collection of fluid under the incision (i.e., a seroma or hematoma), and (c) a cool area of edema which increases tension and impairs tissue perfusion.²

Results: Liver Transplant assessments at a rehabilitation hospital for post-op care. The initial image set identifies non-visual objective assessment data; repeated images confirm treatment efficiency.

Case 1: Shows normal visible and thermal findings.

Case 2: Only normal visible findings are shown; the thermal area shows a cool -5.8˚C area diagnosed as calciphylaxis.

Case 3: Visible mild erythema, with a large thermal area of heat measuring +4.3˚C. Antibiotics were started, and a follow-up image showed the heat resolved to +1.4˚C.

Case 4: Visible erythema without an elevated body temperature; the thermal image ruled out concerns for a fluid collection; repeat image confirms thermal assessment, and the site remains without complications.

Discussion: Surgical site problems remain common, leading to extended hospitalization, readmission, and reoperation, thus increasing costs.³

Combining the clinical and physical history with a thermal assessment provides new objective data for early intervention; additional serial images can be compared to quantify treatment efficacy.

Using LWIT as an assessment adjunct is proactive and encourages improved outcomes.