Using Near Infra-red Spectroscopy to Document the Effectiveness of HBOT on an Atypical Scalp Wound.

Introduction: Near infra-red spectroscopy (NIRS) has been used to evaluate tissue oxygen saturation and perfusion in a variety of clinical settings including wound care, vascular medicine and surgery.  NIRS has also been used to evaluate the patient’s response to a procedure or therapeutic intervention.  This presentation illustrates the efficacy of using NIRS in the evaluation of a patient undergoing hyperbaric oxygen therapy.Methods:  NIRS (SnapshotNIR, Kent Imaging LLC, Calgary, Canada) is a non-invasive imaging device that can measure oxygenated and de-oxygenated levels of hemoglobin in the wound and periwound tissues to calculate and create an image of tissue oxygen saturation. NIRS imaging was used serially to monitor a patient with a large full thickness scalp ulcer following Mohs resection of a squamous cell carcinoma.  The initial excisional defect was closed with a full thickness skin graft, which failed.  The patient was subsequently referred for HBOT.Results: Significant improvement in tissue oxygenation (StO2) pre-and post-hyperbaric treatment session one suggested that the patient would have an excellent response to hyperbaric oxygen treatment. Continued improvement over time in tissue oxygenation also correlated well with the clinical findings of excellent wound healing. The intense early tissue oxygen signal correlating with significant tissue inflammation and perfusion eventually normalized to those of the surrounding tissue. This observation noted on the NIRS imaging matched with the timing of the clinical decision to suspend hyperbaric treatment. Improvements in Sto2 also correlated well with the clinical findings of excellent wound healing.Discussion:  The near-infrared spectroscopy imaging used before and after the first hyperbaric treatment session appears to identify those patients who will benefit from the therapy and may predict positive outcomes with HBOT. This predictability of SnapshotNIR in the management of patients receiving hyperbaric oxygen therapy may be revolutionary. References: