10 About 50–67% of VLU patients exhibiting decreased wound size during the first month of compression therapy will be healed after 6 months treatment, 11 but many VLUs remain refractory to compression treatment as measured by wound size/area. Typically if a wound is not 30% smaller by week 4, it is unlikely to heal by week 12, and such patients are then reassessed or referred for further diagnosis and appropriate management (through advanced therapies along with continued compression). 8, 9 Effectiveness of compression therapy in the healing of the wound is likewise monitored through visual assessment and wound size measurements at times of weekly wound dressings. Currently, physicians assess healing status of chronic wounds by simple visual inspection (wound coloration, texture, and epithelialization) and wound size measurements. VLUs, venous leg ulcers.Ĭompression therapies are typically performed during weeks 0–4 of VLU treatment. These tests can evaluate venous anatomy, and aid or confirm the presence of venous insufficiency and reflux, 7 such that the gold-standard compression therapy can begin upon the onset of venous ulceration.įlow chart showing standard clinical evaluation of VLUs and its initial management. Noninvasive diagnostic tests such as duplex ultrasound (DUS) are used as a gold standard to evaluate reflux in venous ulcers. 6 Clinical evaluation and initial management of VLUs are summarized in Fig. 5 They are mainly diagnosed clinically through comprehensive history and physical examination, with confirmatory venous studies (reflux studies).Ĭhronic venous insufficiency caused by sustained ambulatory venous pressures (aka venous hypertension) is common in the obesity, those with sedentary lifestyle, and leads to a diseased venous system and eventually to venous ulceration. 4 VLUs can last from weeks to years and tend to recur. 3 Typical risk factors tend to include older age, obesity, previous leg injuries, deep venous thrombosis, and phlebitis. 2 VLU incidence is increasing with age at an annual rate of 2.2% among Medicare-aged and 0.5% of younger privately insured Americans. Venous leg ulcers (VLUs) comprise 80% of leg ulcers 1 and affect 2.2 million Americans annually. Innovation: Near-infrared imaging of wounds to assess healing or nonhealing of VLUs from tissue oxygenation changes using a noncontact, handheld, and low-cost imager has been demonstrated for the first time.Ĭonclusion: The tissue oxygenation changes in wound with respect to the surrounding tissue can provide an objective subclinical physiological assessment of VLUs during their treatment, along with the gold-standard visual clinical assessment. In addition, in a very slow-healing wound, wound to background tissue oxygenation contrasts fluctuated and did not converge. Results: It was observed that wound to background tissue oxygenation contrasts in healing wounds diminished and/or stabilized, whereas in the nonhealing wounds it did not. The tissue oxygenation contrast obtained between the wound and surrounding tissue was longitudinally mapped across weeks of treatment of four VLUs (healing and nonhealing cases). Herein, a handheld noncontact near-infrared optical scanner (NIROS) was developed to measure tissue oxygenation of VLUs during weeks of treatment.Īpproach: Continuous-wave-based diffuse reflectance measurements were processed using Modified Beer-Lambert's law to obtain changes in tissue oxygenation (in terms of oxy-, deoxy-, total hemoglobin, and oxygen saturation). Imaging for tissue oxygenation changes surrounding the wounds can objectively complement the subjective visual inspection approach. Clinicians measure the wound size and check for epithelialization. To date, clinicians have employed visual inspection of the wound site to determine the healing progression of a wound. One of the key parameters that can promote healing of VLUs is tissue oxygenation. Objective: Venous leg ulcers (VLUs) comprise 80% of leg ulcers.
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