Jon D Simmons1, Steven A Kahn2, Adrienne L Vickers3, Edward S Crockett4, Jonathon D Whitehead3, Amy K Krecker3, Yann-Leei Lee2, Adam N Miller2, Scott B Patterson2, William O Richards2, Wiltz W Wagner5. 1. Department of Surgery, University of South Alabama School of Medicine, Mobile, AL; Department of Molecular and Cellular Pharmacology, University of South Alabama School of Medicine, Mobile, AL; Center for Lung Biology, University of South Alabama School of Medicine, Mobile, AL. Electronic address: jdsimmons@health.southalabama.edu. 2. Department of Surgery, University of South Alabama School of Medicine, Mobile, AL. 3. University of South Alabama School of Medicine, Mobile, AL. 4. Department of Molecular and Cellular Pharmacology, University of South Alabama School of Medicine, Mobile, AL. 5. Department of Molecular and Cellular Pharmacology, University of South Alabama School of Medicine, Mobile, AL; Center for Lung Biology, University of South Alabama School of Medicine, Mobile, AL.
Abstract
BACKGROUND: Diagnosing the extremes of superficial burns and full-thickness burns is straightforward. It is in the middle ground of partial-thickness burns where the diagnostic difficulties emerge; it can take up to 3 to 5 days for signs of healing to appear. We hypothesize that cooling partial-thickness burns and tracking the rate of rewarming will immediately reflect the condition of the burn: shallow partial-thickness burns that retain cell health and blood flow will rewarm rapidly, and deeper burns with damaged microvessels will rewarm slowly. STUDY DESIGN: We enrolled 16 patients with isolated, partial-thickness burns on their extremities who were diagnosed as indeterminate by our burn surgeon. Within 24 hours after presentation, room-temperature saline was poured over the burn as a cooling challenge. An infrared camera that was sensitive to body temperature produced false-color images showing pixel-by-pixel temperatures. A time-lapse recording from the infrared camera images taken as the burn rewarmed produced a time-temperature curve that reflected the kinetics of rewarming. The outcomes variable was whether or not the patient received a skin graft, which was determined 72 hours after presentation. RESULTS: The method correctly predicted whether or not the patient required a skin graft. CONCLUSIONS: Here we report a new technique that permits determination of wound viability much earlier than clinical examination. Due to the simplicity of the method, non-experts can successfully perform the technique on the first day of the burn and make the correct diagnosis and decision to graft or not to graft.
BACKGROUND: Diagnosing the extremes of superficial burns and full-thickness burns is straightforward. It is in the middle ground of partial-thickness burns where the diagnostic difficulties emerge; it can take up to 3 to 5 days for signs of healing to appear. We hypothesize that cooling partial-thickness burns and tracking the rate of rewarming will immediately reflect the condition of the burn: shallow partial-thickness burns that retain cell health and blood flow will rewarm rapidly, and deeper burns with damaged microvessels will rewarm slowly. STUDY DESIGN: We enrolled 16 patients with isolated, partial-thickness burns on their extremities who were diagnosed as indeterminate by our burn surgeon. Within 24 hours after presentation, room-temperature saline was poured over the burn as a cooling challenge. An infrared camera that was sensitive to body temperature produced false-color images showing pixel-by-pixel temperatures. A time-lapse recording from the infrared camera images taken as the burn rewarmed produced a time-temperature curve that reflected the kinetics of rewarming. The outcomes variable was whether or not the patient received a skin graft, which was determined 72 hours after presentation. RESULTS: The method correctly predicted whether or not the patient required a skin graft. CONCLUSIONS: Here we report a new technique that permits determination of wound viability much earlier than clinical examination. Due to the simplicity of the method, non-experts can successfully perform the technique on the first day of the burn and make the correct diagnosis and decision to graft or not to graft.
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