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Dynamic Optical Coherence Tomography Is a New Technique for Imaging Skin Around Lower Extremity Wounds
摘要： Chronic wounds such as venous leg ulcers invariably heal slowly and recur. In the case of venous leg ulcers, poor healing of chronic wounds is variously attributed to ambulatory hypertension, impaired perfusion and diffusion, presence of chronic inflammation at wound sites, lipodermatosclerosis, and senescence. The aim of this study was to investigate whether a new technique, optical coherence tomography (OCT), which permits imaging of blood capillaries in the peri-wound skin, can provide new insights into the pathology. OCT and its recent variant, dynamic OCT, permit rapid noninvasive depth-resolved imaging of the capillaries in the superficial dermis via a handheld probe, showing the morphology and density of vessels down to 20 μm in diameter. We used dynamic OCT to investigate 15 chronic wounds and assess characteristics of the vessels at the 4 poles around the wounds, the wound bed, adjacent dermatosclerosis, and unaffected skin. The results of the study show that both vessel morphology and density in the wound edges are dramatically different from that in healthy skin, showing clusters of glomuleri-like vessels (knot-like forms or clumps) and an absence of linear branching vessels, and also greater blood perfusion. Such vessel shapes are reported to be associated with tissue growth. The OCT imaging procedure was rapid and well tolerated by patients and provided new information not available from other devices. Thus, OCT appears to have great promise as a tool for the evaluation and study of chronic ulcers.
关键词： capillary imaging,venous leg ulcer,chronic wounds,optical coherence tomography
更新于2025-09-23 15:22:29
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Using Alternative Light Source Technology to Enhance Visual Inspection of the Skin
摘要： BACKGROUND: The identification of deep tissue pressure injury (DTPI) in the early stages of evolution presents a challenge, as skin compromise is only visually apparent when evidence of damage reaches its outer layers. CASE DESCRIPTION: We describe use of an alternative light source (ALS) to enhance visual skin assessment in 3 cases. Case 1 was a 47-year-old African American man with a hyperpigmented inner buttocks and a mixture of partial- and shallow full-thickness skin loss from incontinence-associated dermatitis and friction. Case 2 was a 62-year-old African American woman with a gluteal cleft DTPI. Case 3 was a 57-year-old African American woman with a stage 3 pressure injury of the right buttock. CONCLUSION: The ALS enabled visualization of skin nuances not visible to the unaided eye. Based on this experience, we conclude that use of an ALS provided additional visual details when compared to traditional visual inspection. We found that as the ALS interplays with skin layers, penetrating and absorbing at differing depths, compromised skin appeared darker and more distinct when compared to adjacent, intact skin. Additional research is needed to determine whether the ALS enables earlier pressure injury detection, timelier and more effective intervention, decreased morbidity, and cost savings.
关键词： Alternative light source,Pressure injury,Deep tissue pressure injury,Pressure ulcer
更新于2025-09-23 15:22:29
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A comparative randomized clinical trial to assess the effectiveness of the diode lasers in both contact and non-contact mode and 0.1% triamcinolone acetonide mouth paste in treatment of oral ulcersa??an in vivo study
摘要： Introduction Ulceration is the breach in the oral epithelium, which typically exposes nerve endings in the underlying lamina propria, resulting in pain and soreness. Oral ulcers are very common, with an estimated point prevalence of 4% worldwide. Current treatment options available include topical agents, systemic and topical corticosteroids, cauterization, antibiotics, multivitamins, adhesive pastes, local antiseptics, analgesics, anti-inflammatory, mouth rinses containing active enzymes, and photobiomodulation therapy (PBMT). Laser constitutes an alternative to processes that alleviate pain and inflammatory reaction and is now widely used in management of diseases that require tissue regeneration. Keeping in mind the analgesic, anti-inflammatory, and bio-stimulatory properties of PBMT, we conducted a study to analyze the effectiveness of PBMT in both contact and non-contact mode in relation to pain in ulcer, size, and healing time. Method A total of 45 patients with ulcers were included and randomly divided them into 3 equal groups undergoing laser therapy (contact mode, non-contact mode) and conventional treatment, i.e., 0.1%triamcinolone acetonide. All the patients were examined on day 0, 2, 4, and 6 to check for pain, size of ulcer, and healing time. Also, frequency of recurrence was also assessed in a 1-year follow-up. Results ANOVA followed by post hoc comparison by Bonferroni method was done which revealed that PBMT in non-contact mode provided immediate pain relief and significantly reduced healing time with less recurrence followed by PBMT in contact mode. Conclusion PBMT in non-contact mode was more effective in relieving pain and reducing the healing time during the treatment of oral ulcers compared with triamcinolone acetonide and laser in contact mode. Also, less recurrence was seen even after 1-year of follow-up. Hence, it can be concluded that PBMT in non-contact and contact mode is a safe and clinically effective therapy for treating oral ulcers.
关键词： VAS (visual analogue scale),Photobiomodulation therapy (PBMT),RAU (recurrent aphthous ulcer)
更新于2025-09-23 15:21:01
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A Systematic Review and Meta-Analysis of the Effects of Low-Level Laser Therapy in the Treatment of Diabetic Foot Ulcers
摘要： Diabetic foot ulcers (DFUs) are considered one of the most aggressive and expensive complications of diabetes. Low-level laser therapy (LLLT) has been highlighted as a potential modality of treatment to accelerate the healing of ulcers. This systematic review and meta-analysis aimed to investigate the efficacy of LLLT in the treatment of DFU and identify the LLLT application parameters recommended for the treatment of DFU over the past 10 years. A systematic search was conducted in PubMed, BVS, PEDro, Scopus, Web of Science, and CINAHL up to March 31, 2019. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines, randomized controlled trials (RCTs) that assessed the effect of LLLT on the treatment of DFU were included. Thirteen RCTs with a total of 361 participants were included in this review. Three RCTs reported a reduction in the percentage size of the ulcers and were included in the meta-analysis. The meta-analysis of the percentage size difference demonstrated a significant reduction in ulcer size in the LLLT group compared with controls (22.96 [95% confidence interval = 18.22-27.69; z = 9.51, P < .0001]). Treatment with 632.8 to 685 nm, 50 mW/cm2, 3 to 6 J/cm2, and irradiation for 30 to 80 seconds, 3 times weekly for a month is of benefit to patients with DFU. LLLT is effective and safe for the treatment of DFU. Additionally, well-designed, high-quality studies are needed to allow its ideal parameterization for clinical practice.
关键词： diabetic foot ulcer,meta-analysis,low-level laser therapy,systematic review
更新于2025-09-23 15:21:01
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A prospective safety and effectiveness study using endovenous laser ablation with a 400-??m optical fiber for the treatment of pathologic perforator veins in patients with advanced venous disease (SeCure trial)
摘要： Background: Treatment of pathologic perforator veins (PPVs) can shorten time to healing and reduce recurrence of ulcers in patients with advanced venous disease. Because of limited clinical evidence and device options, widespread adoption of PPV treatment is controversial. The objective of this study was to evaluate the safety and efficacy of endovenous laser therapy using a 400-mm optical fiber to treat PPVs. Methods: This study was a single-arm, prospective, seven-center, nonblinded clinical study examining patients with advanced skin changes or healed or active ulceration (Clinical, Etiology, Anatomy, and Pathophysiology clinical class C4b, C5, and C6). Patients received treatment with a 1470-nm laser. Procedural technical success and 10-day primary closure were evaluated. All device-related adverse events were reported. Follow-up of patients was continued for 12 months after initial ablation. Results: The primary PPV closure (at 10-day visit) rate was 76.9% (95% confidence interval, 70.3%-82.4%). Successful primary closure rates of 75.7%, 70.3%, 62.1%, 68.8%, and 71.3% of PPVs were achieved at 1 month, 3 months, 6 months, 9 months, and 12 months, respectively. Statistically significant improvements (P< .05) were seen in patients’ quality of life at 1 month, 3 months, 6 months, 9 months, and 12 months compared with screening. The percentage of patients with ulcers (22.9% at screening, 14.1% at 1 month, 13.7% at 3 months, 10.1% at 6 months, 12.3% at 9 months, and 11.1% at 12 months) displayed improvement during the course of the study. Tibial deep venous thrombosis and procedural pain were the only device-related adverse events observed. Conclusions: Endovenous laser therapy for PPV using the 400-mm optical fiber with the 1470-nm laser yielded safe and effective outcomes with no major adverse sequelae.
关键词： Perforators,Venous ulcer,Venous insufficiency,Endovenous laser,QOL
更新于2025-09-23 15:19:57
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Validation of low-cost smartphone-based thermal camera for diabetic foot assessment
摘要： Infrared thermal imaging (IR) is not yet routinely implemented for early detection of diabetic foot ulcers (DFU), despite proven clinical effectiveness. Low-cost, smartphone-based IR-cameras are now available and may lower the threshold for implementation, but the quality of these cameras is unknown. We aim to validate a smartphone-based IR-camera against a high-end IR-camera for diabetic foot assessment. Methods: We acquired plantar IR images of feet of 32 participants with a current or recently healed DFU with the smartphone-based FLIR-One and the high-end FLIR-SC305. Contralateral temperature differences of the entire plantar foot and nine pre-specified regions were compared for validation. Intra-class correlations coefficient (ICC(3,1)) and Bland-Altman plots were used to test agreement. Clinical validity was assessed by calculating statistical measures of diagnostic performance. Results: Almost perfect agreement was found for temperature measurements in both the entire plantar foot and the combined pre-specified regions, respectively, with ICC values of 0.987 and 0.981, Bland-Altman plots’ mean Δ=-0.14 and Δ=-0.06. Diagnostic accuracy showed 94% and 93% sensitivity, and 86% and 91% specificity. Conclusions: The smartphone-based IR-camera shows excellent validity for diabetic foot assessment.
关键词： Smartphone,Thermal Infrared,Diabetes Mellitus,Diabetic Foot,Foot Ulcer,Temperature
更新于2025-09-19 17:15:36
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Laser therapy for recurrent aphthous stomatitis: an overview
摘要： Objectives To evaluate therapeutic effects of laser therapy on patients with recurrent aphthous stomatitis assessing evidences from previously published systematic reviews. Materials and methods An overview of systematic reviews was conducted based on PRISMA checklist. Search strategies were developed and adapted for six different electronic databases and a gray literature search was also performed. The methodology quality of the included systematic reviews was assessed by the Measurement Tool to Assess the Methodological Quality of Systematic Reviews 2 (AMSTAR 2). Results After a two-step selection, five systematic reviews were included. Methodology quality was considered as a high risk of bias in two systematic reviews, while in the other three were graded as moderate. The systematic reviews’ conclusions demonstrated that all included systematics reviews showed positive effects of laser therapy for pain relief, and most of them demonstrated healing improvement. A meta-analysis was not feasible due to heterogeneity in treatments parameters. Conclusions Evidence suggested that laser therapy is an effective tool to treat recurrent aphthous stomatitis; nevertheless, more randomized clinical trials should be conducted to compare different lasers parameters. Clinical relevance The present overview evaluated recent evidence about laser therapy for recurrent aphthous stomatitis management in order to contribute for evidence-based dentistry and decision-making. This overview suggests that laser therapy is a safe and promising alternative to treat recurrent aphthous stomatitis, since it promotes wound healing and pain relief.
关键词： Evidence-based medicine,Lasers,Oral medicine,Overview,Systematic review,Oral ulcer
更新于2025-09-16 10:30:52
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Comparison of combined compression and surgery with high ligation-endovenous laser ablation-foam sclerotherapy with compression alone for active venous leg ulcers
摘要： We aimed to assess the ulcer healing time and recurrence rates after treatment with compression therapy (ct) with or without high ligation-endovenous laser ablation-foam sclerotherapy (HL-eVLA-fS) in people with active venous leg ulcers (VLUs). A retrospective cohort study was conducted with 350 patients with active VLUs treated by compression with or without HL-eVLA-fS in our hospital from 2013 to 2017. The primary outcome was the ulcer healing time; secondary outcomes were the 12-month recurrence rates, the relationship between recurrence and venous reflux, and the complications of the two treatments. In total, 193 patients (200 limbs) underwent compression plus HL-EVLA-FS, and 157 patients (177 limbs) underwent CT alone. The ulcer healing time was shorter in the compression plus HL-EVLA-FS group than in the CT alone group (Hazard Ratio [HR] for ulcer healing, 1.845 [95% CI, 1.474–2.309], P = 0.0001). The 12-month ulcer recurrence rates were significantly reduced in the compression plus HL-EVLA-FS group (HR for ulcer recurrence, 0.418 [95% CI, 0.258–0.677], P = 0.0001). Calf perforator vein reflux (CPVR) and isolated superficial venous reflux (ISVR) were risk factors for ulcer recurrence. the combined operation with ct resulted in faster healing of VLUs, a lower ulcer recurrence rate and lower VcSS values after intervention than ct alone.
关键词： venous leg ulcers,ulcer healing time,high ligation-endovenous laser ablation-foam sclerotherapy,compression therapy,recurrence rates
更新于2025-09-16 10:30:52
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Quantitative Analysis of Heel Skin Microcirculation Using Laser Doppler Flowmetry and Tissue Spectrophotometry
摘要： OBJECTIVE: To examine perfusion changes in the heel skin of individuals with and without diabetes mellitus to understand how skin is pathologically affected by diabetes mellitus. METHODS: This case-control study was conducted at an academic hospital in Tuebingen, Germany. A total of 30 subjects were enrolled in the study: 15 with known type 2 diabetes mellitus and 15 without. Each subject was asked to lie in a supine position on a hard lateral transfer mat for 10 minutes. MAIN OUTCOME MEASURES: Heel perfusion was quantitatively assessed directly after relief of pressure and after 3 and 6 minutes after relief of pressure using laser Doppler flowmetry and tissue spectrophotometry. MAIN RESULTS: Directly after relief of pressure, blood flow increased in the superficial skin layers (2 mm below the surface of the skin) in both groups. However, in deep skin layers (8 mm below the surface of the skin), blood flow increased in patients with diabetes mellitus and decreased in healthy patients. Oxygen saturation (SO2) was higher in healthy subjects directly after pressure relief. CONCLUSIONS: The increase in blood flow in superficial skin layers indicates reactive hyperemia after exposure in both groups. The prolonged hyperemia in deep skin layers in patients with diabetes indicates increased tissue vulnerability. Despite the increase in blood flow in deep skin layers, the SO2 and thus supply of tissue in patients with diabetes were reduced.
关键词： diabetes mellitus,pressure injury,oxygen saturation,blood flow,perfusion,diabetic foot ulcers,laser Doppler flowmetry,pressure ulcer,microcirculation
更新于2025-09-12 10:27:22
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Periulcer Foam Sclerotherapy Injection in Chronic Venous Leg Ulcers Using Near-Infrared Laser for Vein Visualization
摘要： High recurrence and high costs of treatment are the main problems with venous ulcer management. Therefore, it is of utmost importance to target the exact pathological cause. The role of cutaneous microvalves reflux in the pathogenesis of these ulcers has been confirmed. In this study, 20 chronic venous leg ulcers were prospectively subjected to foam sclerotherapy injection into periulcer veins using direct visualization by AccuVein AV400. Patients having infected ulcers, acute deep vein thrombosis, hypercoagulability, Ankle-Brachial Index <0.9, pregnancy, and/or allergy to the sclerosant were excluded. Endpoints included rates of ulcer size reduction, complete healing, ulcer recurrence, and procedure-related complications. Aethoxysklerol 1% was used in all cases to produce foam employing the double-syringe system. The mean reduction in ulcer surface area, postinjection, was 75% after 8 weeks and 91% after 12 weeks. Nineteen ulcers (95%) healed in a median time of 8 weeks, range 3 to 17 weeks. At 1 year of follow-up, 18 patients (90%) were still ulcer-free, while 1 patient’s ulcer (5%) recurred 19 weeks postinjection. No major complications were encountered. Periulcer foam sclerotherapy injection, guided by vein visualization technology, should be one of the main lines of treatment of venous leg ulcers. It offers good results with regard to rapid ulcer healing and low recurrence rate without major risk. Randomized controlled trials are needed to establish these conclusions.
关键词： periulcer injection,venous ulcer,AccuVein 400,chronic ulcer,foam sclerotherapy
更新于2025-09-11 14:15:04