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Case Series/Study
Wound healing can be affected by various factors, including compromised blood circulation, devitalized tissue with a high bioburden and other wound elements such as tunneling, undermining. In literature, ischemic areas are reported to have lower temperature values compared to unaffected areas1,2. This case series explores the utility of combined thermal and fluorescence imaging in providing additional point-of-care information to aid in the assessment of wounds, as it relates to cooler areas from ischemic or devitalized tissues, tunnels, undermining or hidden wound pockets and may offer insights into the patient's underlying vascular condition.
Methods:
Ten patients with pressure injuries, venous leg ulcers, and diabetic foot ulcers at two out-patient clinics were assessed using a novel handheld device* that combines thermal and bacterial fluorescence imaging. Thermal images were taken approximately 5 minutes after the wounds were undressed (acclimatization period) but prior to cleansing or debridement. Fluorescence wound imaging was then performed in darkness including co-registered image capture of fluorescence and thermal. The results of both standard clinical assessment and wound imaging were recorded, along with any associated impact on treatment decision-making with the purpose of establishing their relationship.
Results: Across the 10 wounds, abnormally cool temperatures observed presented in two different scenarios. Hidden tunneling and undermining, and deep unstageable pressure injury areas appeared as localized, well circumscribed areas of cooler temperature readings, in close proximity or in relation to the wound. Venous insufficiency was represented by an extensive, widespread cool temperature. Thermal imaging guided the clinician to these areas that were not immediately apparent in their clinical assessment. Fluorescence imaging further confirmed the presence of bioburden within devitalized tissues enabling targeted debridement.
Discussion: This case series highlights the advantages of combining thermal and fluorescence imaging modalities into a single handheld device. This combination, together with clinical assessment, revealed not always apparent wound complications such as tunneling or undermining, as well as underlying comorbidities like vascular insufficiency. By identifying these issues at the point of care, clinicians were able to adjust their treatment plans accordingly.