Advances in Wound Care Technology: What We See Is What We Get … and More

The science of wound care dressings has progressed a long way over the years, especially during the not-too-distant past. As recently as the early 1990s, the main dressings available to patients included transparent films, hydrocolloids, foam, and calcium alginate. Although not incredibly common, moist wound care was also utilized more than many clinicians would care to admit some 30 years later. Standard dressings at the time were wet-to-dry and betadine.

Today, dressing technology has transitioned from a passive to an active role. Yet, the sophistication of dressings that our patients enjoy today would not be possible without understanding the clinical progression that has occurred, even among those treatments that have since been abandoned.  

Wound care continues to advance in technology as never seen before. Wearable technology, electronic health records, and an exciting array of devices are available in the market to help us gather important data at deeper levels than visually seen through examination and dressings alone. Now we are able to get real-time information on what’s happening below the skin surface.  

As the adage goes, a picture is worth a thousand words. But, somehow, this common phrase seems to have new meaning today when considering the use of new devices. This article will examine three particular devices that should catch the attention of any wound care clinicians seeking innovative ways to achieve best practices. This article is not intended to promote one device in particular. This article is also not all-inclusive. My new statement as I’m gaining hands on experience with these devices is that an image is worth a thousand clinical words.

A Closer Look at Non-Contact, Non-Invasive Devices

Near-infrared spectroscopy technology offers handheld imaging devices that can capture tissue oxygenation to help us look at microcirculation through point-and-shoot technology (Snapshot_NIR, Kent Imaging). Another advancement in the field has been the ability to easily measure and visualize bacteria at the point of care with fluorescence imaging (MolecuLight i:X Wound Imaging Device, MolecuLight). Long-wave infrared technology (LWIT) allows for objective and quantitative measurement of skin temperature images to aid in assessments, early prevention, and clinician validation (Scout, WoundVision). These technologies are cleared by the Food and Drug Administration (FDA), easy to learn, and provide needed data to complement assessment, documentation, and/or treatment validation. Let’s briefly look at each example.

Snapshot_NIR. Rapidly measures tissue oxygenation saturation (StO₂) in superficial tissue utilizing multiple wavelengths of near-infrared light (NIR). It captures relative amounts of oxygenated and deoxygenated hemoglobin in the microcirculation. This provides needed information to determine tissue viability, help clinicians guide care, and improve outcomes. My curiosity has led me to compare tissue oxygenation saturation, deoxyhemoglobin, oxyhemoglobin, and total hemoglobin images prior to and after hyperbaric treatments, surgical interventions, revascularization procedures, and to complement patient evaluations as an easy to use, cost effective and noninvasive device. The objective data collected has helped determine microvascular status and drive interventions. This device differs from thermography and is impressive, as it provides valuable data since we know that poor oxygenation impairs healing.

MolecuLight i:X. This is a portable fluorescence imaging device that provides visualization of pathogenic bacteria and tissues while having the ability to measure the wound surface area at the point of care. There’s evidence that indicates this device is valuable when honing in bacteria for wound progression. This technology allows for accurately assessing wounds, targeting sampling for bacteria, debridement, treatment selection, monitoring wound progression, and wound documentation. There is plenty of data available on this non-invasive imaging device related to appropriate debridement and bacterial control, which are essential components of wound bed preparation.  

Scout. A combination digital and long-wave infrared camera that is approved as a visual and thermal imaging device with a software analysis tool. Long wave infrared thermography (LWIT) can measure radiant heat from a body surface.¹ As the heat or energy is emitted, thermal images are captured from electromagnetic wavelengths that can be seen in real time. This body heat is a result of cellular metabolism. In addition, it also detects when loss of heat or energy is experienced, such as in the case of impaired blood flow to the skin (hypoperfusion). These images can provide information regarding temperature readings based on a color scale. The device is able to help determine if inflammation, infection, or hypoperfusion are present, and to what severity.
In practice, this device has been useful to early predict and prevent pressure injuries, as well as across the continuum of care for determining the level of inflammation or infection before classic signs are noted. Langemo in 2017 demonstrated how LWIT can quantitatively measure an area of interest’s progression or regression.²

Summary

Chronic wounds are stalled in the inflammatory phase and being able to use technology to determine the level of such a state has led us to make prompt referrals or guide us in selecting appropriate interventions.

When it comes to early recognition and prompt action, let’s compare ulcers to other conditions such as a myocardial infarction and a cerebrovascular accident. We understand that during a heart attack, time is muscle; while during a stroke, time is brain; and for a patient with an ulcer such as a diabetic foot ulcer, time is tissue. Wound healing is an overlapping and timely cascade of events, but when we see chronic wounds, we know they are stuck in the inflammatory phase, thus possibly inflicting damage to healthy tissue with a likelihood of amputation and loss of life. Capturing tissue oxygenation levels using NIRS, determining the presence/absence of bacterial levels with a fluorescence image device, and thermography images will help us select treatment interventions much sooner and determine how we are progressing from the inflammatory to the proliferative phase.

In conclusion, these devices are a must as they offer advance imaging technology that can provide us with instant non-invasive valuable information to determine surface tissue oxygenation, visualization of pathogenic bacteria, and measure radiant heat from the body. Adopting the use of this new and available technology in our daily practice can positively impact our outcomes and enhance patient care.

Frank Aviles Jr. is wound care clinical coordinator at Natchitoches (LA) Regional Medical Center; wound care and lymphedema instructor at the Academy of Lymphatic Studies, Sebastian, FL; physical therapy (PT)/wound care consultant at Louisiana Extended Care Hospital, Natchitoches; and PT/wound care consultant at Cane River Therapy Services LLC, Natchitoches.

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References
1. Bird HA, Ring EF. Thermography and radiology in the localization of infection. Rheumatol Rehabil. 1978;17(2):103-106.
2. Langemo DK, Spahn JG. A reliability study using a long-wave infrared thermography device to identify relative tissue temperature variations of the body surface and underlying tissue. Adv Skin Wound Care. 2017; 30(3):109–19. doi: 10.1097/01.ASW.0000511535.31486.bb