A Retrospective Evaluation of Digital Wound Imaging to Predict Response to Hyperbaric Oxygen Treatment

  • Wed, 9/3/08 - 10:25am
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Author(s): 
John Kalns, PhD; Anuradha Roy, PhD; CleAnn Loeffler, BS; James K. Wright, MD, FACS

K nowledge regarding the biochemical reasons for wound healing failure has grown significantly in recent years; however, transforming this knowledge into clinically useful diagnostic tools and treatments has been slow to occur. For example, studies have shown that growth factor deficits,1 increased activity of metalloproteases,2-4 reduced nitric oxide production,5 and low availability of oxygen in the wound bed6 are factors associated with nonhealing. Systemic dysfunction caused by advanced age,7 renal failure,8 and chronic diseases such as AIDS9 also adversely affect healing. However, laboratory tests to determine specific wound deficiencies, enabling rational selection of treatment, are not available. Instead, treatment decisions are made using subjective clinical assessment and the particular bias the caregiver may have regarding available treatment options. Clinical practice studies show that wound treatment is inconsistent and frequently not based on a rational analysis of the factors contributing to a chronic wound.10 Additionally, in some cases, treatments that are empirically sound may actually be deleterious to wound healing.11 Despite recent advances in knowledge, the prognosis for many patients suffering from chronic, nonhealing wounds remains poor. For example, approximately 45% of patients with diabetes and chronic nonhealing wounds of the lower extremities will eventually require amputation.12

As new, effective, and in all likelihood, expensive treatments become available, correct initial treatment selection and dynamic modification of regimens, based on wound response to treatment, must be applied to improve patient outcome and reduce cost. Biochemical assessment of the wound appears to be a rational approach to treatment selection and monitoring but is not yet standardized or validated and the cost is high. As an alternative, wound morphometry using digital wound images may be an effective means of evaluating wound response to treatment in real time. This will enable a dynamic approach, where treatments can be evaluated and subsequently changed if wound-healing response proves negligible.

Wound areas or volumes have been used to evaluate the effects of treatment. Several measures have been proposed. These include wound area measurement by tracing the wound outline on an acetate placed over the wound,13 measuring the volume of saline required to fill the wound,14 digital image capture with color-based image analysis,15 and biochemical markers of wound treatment response.16 However, all these methods have unique limitations. Casts, tracings, and saline filling are invasive and time consuming, while many image analysis strategies require specialized equipment, training, and extensive set-up in order to optimize image quality. Biochemical measurements are expensive and the applicability to many types of wounds and treatments is as yet unproven.

To test the hypothesis that digital images of wounds obtained with conventional digital cameras are of sufficient quality to make a meaningful assessment of treatment response, a digital archive of wound images was evaluated retrospectively in order to evaluate the healing characteristics of patients receiving hyperbaric oxygen treatment (HBOT) - specifically, that digital images taken during the first 3 weeks of treatment and other patient data (ie, age, smoking history, diabetes diagnosis, blood glucose, and serum creatinine) will predict the eventual response to HBOT.

References: 

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