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Index: WOUNDS 2011;23(9):276–284

  Abstract: Hemodynamic 3D infrared thermal stereoscopic imaging (TSI) was tested as a new non-invasive diagnostic method for studying chronic vascular leg ulcers. The aim was to test this new diagnostic approach in investigating mixed arterio-venous wounds. Duplex ultrasonography is the most useful test for investigating hemodynamic alterations in patients with vascular cutaneous ulcers; however, it fails to provide any information about microvascular dysfunctions, which could play a significant role in the development of skin wounds. The study of thermal patterns at the wound site represents a method of investigating cutaneous microcirculation—temperature gradients indicating abnormal blood flow in the margins and bed of wounds with vascular disorders are well correlated with clinical findings. Methods. In order to evaluate the predominance of the arterial or venous component in vascular mixed ulcers of the leg and to understand the underlying pathology of the ulcers, 3D thermography was tested in three different hemodynamic positions. A total of 20 physiological and 20 pathological patients were assessed standing, supine, or in a discharging position (legs raised above heart level). Results. A relatively constant temperature trend was observed in healthy subjects, while a different reaction was recorded in those with ulcerated legs. Moreover, a different temperature trend was noted among the varying hemodynamic positions and a trend difference was also observed between arterial and venous ulcers in clinical investigation tests. Conclusion. TSI appears to be a safe, user-friendly, rapid, and promising procedure for distinguishing both arterial and venous involvement in mixed arterio-venous leg ulcers.

  In the Western world, leg ulcers are mainly caused by venous insufficiency, arterial insufficiency, neuropathy, diabetes, or a combination of these factors. Venous ulcers are the most common type of leg ulcers and account for approximately 70% of cases.¹ Arterial disease accounts for 5% and mixed venous and arterial wounds accounts for 20% of total cases of leg ulcers.¹ Venous ulcers have a considerable socioeconomic impact in Western countries due to their high prevalence, cost of investigations and treatment, and loss of working days. .² Venous ulcers occur in » 0.3% of the adult population in Western countries.³ The prevalence of combined active and healed ulcers is » 1%.⁴ The overall prognosis of venous leg ulcers is poor: only 50% heal at 4 months,⁵ 20% remain open at 2 years, and 8% remain open at 5 years.⁶ The annual recurrence rate varies from 6% to 15%.⁷ The annual cost of venous ulcers has been estimated to be £400 to £600 million for the United Kingdom⁸ and more than $1 billion for the United States.⁹ The total cost of chronic venous insufficiency to society, both direct and indirect, is estimated to be $1 billion (US) in each of three European countries (Germany, France, and the United Kingdom).

  Duplex ultrasonography is the most useful test for investigating hemodynamic alterations in patients with suspected venous or arterial cutaneous ulcers. Duplex ultrasonography can detect, localize, and grade venous obstruction, valvular incompetence, and arterial stenosis.¹ However, it fails to provide any information about possible microvascular dysfunctions, which could play a significant role in tissue breakdown and the development of skin wounds.¹⁰

  The study of thermal patterns at the wound site represents a method of investigating cutaneous microcirculation.