Solving the Burn Depth Puzzle
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These studies raise interesting questions: What constitutes healing early enough to support the decision not to excise and graft? What is the better operational definition of “early healing,” 14 or 21 days?
Now is the time to unify the language and units of laser Doppler flux, while the field is young, so that results can be compared across studies. It’s time to clarify the common global language of wound depth and of LDF measures so all can use the results more consistently to improve patient care and outcomes. These researchers have shown LDF to be a robust tool in estimating burn depth and consistently predicting burn healing times. The findings are consistent across age and skin pigment groups. They have verified its diagnostic and screening validity.
These results have clinical implications beyond burn depth diagnosis. LDF is useful for diagnosing other skin and wound conditions3 and for evaluating potential wound treatment applications. For example, LDF has been instrumental in discovering that hydrogen peroxide cream4 and retinoic acid pretreatment5 can ameliorate ischemic tissue damage. What else can LDF measures of vascular perfusion tell us? What if the wound depth findings could be applied to other chronic wounds such as pressure ulcers of “unknown depth” or “deep tissue injury”? Could it help improve reliability of pressure ulcer staging? Would LDF of chronic ulcers predict their timely or delayed healing? Could LDF cue staff when to call for a vascular consult? Once we all speak the same language, and the technology size and price improve, imagine how LDF could help the field of wound care clarify operational definitions of wound depth, recognize risk of delayed healing, and identify effective preventive or treatment modalities for wound care.
1. Monstrey S, Hoeksema H, Verbelen J, Pirayesh A, Blondeel P. Assessment of burn depth and burn wound healing potential. Burns. 2008;34(6):761–769.
2. Chatterjee JS. A critical evaluation of the clinimetrics of laser Doppler as a method of burn assessment in clinical practice. J Burn Care Res. 2006;27(2):123–130.
3. Tur E. Cutaneous blood flow. Laser Doppler velocimetry. Int J Dermatol. 1991;30(7):471–476.
4. Tur E, Bolton L, Constantine BE. Topical hydrogen peroxide treatment of ischemic ulcers in the guinea pig: blood recruitment in multiple skin sites. J Am Acad Dermatol. 1995;33(2 Pt 1):217–221.
5. Shannon RJ, Bolton L. The use of retinoic acid to minimize skin damage. European Patent Specification EP-0448213. May 15, 1996.