Evaluation of healing of pressure ulcers through thermography: a preliminary study
Chaves, Maria Emília Abreu; Silva, Fernanda Souza; Soares, Viviane Pinheiro Campos; Ferreira, Rafael Augusto Magalhães; Gomes, Flávia Sampaio Latini; Andrade, Roberto Márcio de; Pinnoti, Marcos
http://dx.doi.org/10.1590/2446-4740.0571
Res. Biomed. Eng., vol.31, n1, p.3-9, 2015
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Views: 951
Abstract
Introduction: Thermography is a surface thermal radiation measurement technique whose application has been expanding in the healthcare fi eld. The unhealed wound is a serious public health problem because it intervenes in the quality of life of patients and may cause emotional and psychological losses. The wound temperature can provide quantitative data that allow for the healing process to be monitored. The aim of this study was to verify whether thermography can be used as a method to evaluate the healing of pressure ulcers. Methods: Eight participants with sacral pressure ulcers were recruited and randomly divided into two groups: A (control) and B (experimental). Both groups received standard treatment for a period of four weeks, which consisted of a daily cleaning of the pressure ulcers with physiological saline (sodium chloride 0.9%) followed by an alginate hydrogel dressing. The group B received light-emitting diode (LED) phototherapy in addition to standard treatment, three times a week, yielding a total of 12 sessions. Photographs and thermograms of each pressure ulcer were obtained in all sessions in both groups. Results: Pressure ulcers treated with LED phototherapy were healed. The pressure ulcer area of group B decreased over the 12 treatment sessions, whereas the pressure ulcer area of group A increased. The ulcer temperature of group B was higher than that of group A during the treatment (temperature difference up to 7.6%). Discussion: The present study suggests a relationship between the temperature and area of pressure ulcers and proposes thermography as an adjunctive method for the evaluation of healing processes.
Keywords
Thermography, Wound healing, Pressure ulcer.
References
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Bernard V, Staffa E, Mornstein V, Bourek A. Infrared camera assessment of skin surface temperature: effect of emissivity. Physica Medica 2013; 29(6):583-91. http://dx.doi.org/10.1016/j.ejmp.2012.09.003. PMid:23084004
Bostock H, Campero M, Serra J, Ochoa JL. Temperaturedependent double spikes in C-nociceptors of neuropathic pain patients. Brain 2005; 128(Pt 9):2154-63. http://dx.doi.org/10.1093/brain/awh552. PMid:15947060
Bronzino JD. Medical devices and systems. Boca Raton: CRC Press; 2006. http://dx.doi.org/10.1201/9781420003864.
Bryant RA, Nix DP. Acute and chronic wounds: current management concepts. 4th ed. St. Louis: Elsevier Mosby; 2012.
Caetano KS, Frade MA, Minatel DG, Santana LA, Enwemeka CS. Phototherapy improves healing of chronic venous ulcers. Photomedicine and Laser Surgery 2009; 27(1):111-8. http://dx.doi.org/10.1089/pho.2008.2398. PMid:19196110
Calado CR, Calado FAR, Caput G, Gomes SC, Andrade RM. Porosity and delamination defect detection in ceramic materials by active infrared thermography and optical digital microscopy. Materials Science Forum 2014; 798-799:671-6. http://dx.doi.org/10.4028/www.scientific.net/MSF.798-799.671.
Christensen J, Matzen LH, Vaeth M, Schou S, Wenzel A. Thermography as a quantitative imaging method for assessing postoperative inflammation. Dento Maxillo Facial Radiology 2012; 41(6):494-9. http://dx.doi.org/10.1259/dmfr/98447974. PMid:22752326
Corazza AV, Jorge J, Kurachi C, Bagnato VS. Photobiomodulation on the angiogenesis of skin wounds in rats using different light sources. Photomedicine and Laser Surgery 2007; 25(2):102-6. http://dx.doi.org/10.1089/pho.2006.2011.PMid:17508845
Datasus. [cited 2012 July 11]. Available from: http://www.datasus.gov.br/.
Erdle BJ, Brouxhon S, Kaplan M, Vanbuskirk J, Pentland AP. Effects of continuous-wave (670-nm) red light on wound healing. Dermatologic Surgery 2008; 34(3):320-5. PMid:18177400.
European Pressure Ulcer Advisory Panel - EPUAP. National Pressure Ulcer Advisory Panel - NPUAP. Treatment of pressure ulcers: quick reference guide. Washington: National Pressure Ulcer Advisory Panel; 2009.
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Frize M, Ogungbemile A. Estimating rheumatoid arthritis activity with infrared image analysis. Studies Health Technolology Informactcs 2012; 180:594-8. PMid:22874260.
Garcia A, Siddiqui A. Pressure ulcers: the role of thermography and the need to revisit staging. Ostomy/Wound Management 2012; 58(12):10. PMid:23392647.
Haddad DS, Brioschi ML, Arita ES. Thermographic and clinical correlation of myofascial trigger points in the masticatory muscles. Dento Maxillo Facial Radiology 2012; 41(8):621-9. http://dx.doi.org/10.1259/dmfr/98504520.PMid:23166359
Huang CL, Wu YW, Hwang CL, Jong YS, Chao CL, Chen WJ, Wu YT, Yang WS. The application of infrared thermography in evaluation of patients at high risk for lower extremity peripheral arterial disease. Journal of Vascular Surgery 2011; 54(4):1074-80. http://dx.doi.org/10.1016/j.jvs.2011.03.287. PMid:21784604
Karu TI. Low-power laser therapy. In: Vo-Dinhed T. Biomedical Photonics Handbook. Florida: CRC Press; 2003.
Kateb B, Yamamoto V, Yu C, Grundfest W, Gruen JP. Infrared thermal imaging: a review of the literature and case report. NeuroImage 2009; 47(2, Suppl 2):T154-62. http://dx.doi.org/10.1016/j.neuroimage.2009.03.043. PMid:19332140
Kramer JD, Kearney M. Patient, wound, and treatment characteristics associated with healing in pressure ulcers. Advances in Skin & Wound Care 2000; 13(1):17-24. PMid:11061706.
Lanzafame RJ, Stadler I, Kurtz AF, Connelly R, Peter TA, Brondon P, Olson D. Reciprocity of exposure time and irradiance on energy density during photoradiation on wound healing in a murine pressure ulcer model. Lasers in Surgery and Medicine 2007; 39(6):534-42. http://dx.doi.org/10.1002/lsm.20519. PMid:17659591
Lyder CH. Pressure ulcer prevention and management. Journal of the American Medical Association 2003; 289(2):223-6. http://dx.doi.org/10.1001/jama.289.2.223. PMid:12517234
Minatel DG, Frade MAC, França SC, Enwemeka CS. Phototherapy promotes healing of chronic diabetic leg ulcers that failed to respond to other therapies. Lasers in Surgery and Medicine 2009; 41(6):433-41. http://dx.doi.org/10.1002/lsm.20789. PMid:19588536
Nagase T, Sanada H, Takehara K, Oe M, Iizaka S, Ohashi Y, Oba M, Kadowaki T, Nakagami G. Variations of plantar thermographic patterns in normal controls and non-ulcer diabetic patients: novel classification using angiosome concept. Journal of Plastic, Reconstructive & Aesthetic Surgery 2011; 64(7):860-6. http://dx.doi.org/10.1016/j.bjps.2010.12.003. PMid:21257357
Nakagami G, Sanada H, Iizaka S, Kadono T, Higashino T, Koyanagi H, Haga N. Predicting delayed pressure ulcer healing using thermography: a prospective cohort study. Journal of Wound Care 2010; 19(11):465-6. http://dx.doi.org/10.12968/jowc.2010.19.11.79695. PMid:21135794
Perricone N. How to approach acute and chronic wound healing in the elderly. Wounds 1999; 11(6):145-51.
Rich PB, Dulabon GR, Douillet CD, Listwa TM, Robinson WP, Zarzaur BL, Pearlstein R, Katz LM. Infrared thermography: a rapid, portable, and accurate technique to detect experimental pneumothorax. The Journal of Surgical Research 2004; 120(2):163-70. http://dx.doi.org/10.1016/j.jss.2004.02.026. PMid:15234209
Robson MC, Hill DP, Woodske ME, Steed DL. Wound healing trajectories as predictors of effectiveness of therapeutic agents. Archives of Surgery 2000; 135(7):773-7. http://dx.doi.org/10.1001/archsurg.135.7.773. PMid:10896369
Rocha CLJV. Histophysiology and classification of burn: consequences of local systems and tissue loss in patients burnt. Revista Interdisciplinar de Estudos Experimentais 2009; 1(3):140-7.
Saito H, Omura K, Tateyama M. Alternating monomeric paresis with decreased skin temperature and hyperhidrosis in a case of thoracolumbar myelopathy. Clinical Autonomic Research 2000; 10(2):77-80. http://dx.doi.org/10.1007/BF02279895. PMid:10823339
Sayre EK, Kelechi TJ, Neal D. Sudden increase in skin temperature predicts venous ulcers: a case study. Journal of Vascular Nursing 2007; 25(3):46-50. http://dx.doi.org/10.1016/j.jvn.2007.06.002. PMid:17723909
Skene AI, Smith JM, Doré CJ, Charlett A, Lewis JD. Venous leg ulcers: a prognostic index to predict time to healing. British Medical Journal 1992; 305(6862):1119-21. http://dx.doi.org/10.1136/bmj.305.6862.1119. PMid:1463945
Sousa AP, Santos JN, Reis JA Jr, Ramos TA, Souza J, Cangussú MCT, Pinheiro ALB. Effect of LED phototherapy of three distinct wavelengths on fibroblasts on wound healing: a histological study in a rodent model. Photomedicine and Laser Surgery 2010; 28(4):547-52. http://dx.doi.org/10.1089/pho.2009.2605. PMid:20001321
Tada K, Ikeda K, Tomita K. Effect of polarized light emitting diode irradiation on wound healing. The Journal of Trauma Injury Infection and Critical Care 2009; 67(5):1073-9. http://dx.doi.org/10.1097/TA.0b013e318187ad02. PMid:19680158
Teixeira GGD. Metrological reliability in thermography applied for electrical systems [dissertation]. Belo Horizonte: Universidade Federal de Minas Gerais; 2012.
Vermolen FJ, Javierre E. Computer simulations from a finite-element model for wound contraction and closure. Journal of Tissue Viability 2010; 19(2):43-53. http://dx.doi.org/10.1016/j.jtv.2009.11.003. PMid:20022249
Whelan HT, Buchmann EV, Dhokalia A, Kane MP, Whelan NT, Wong-Riley MTT, Eells JT, Gould LJ, Hammamieh R, Das R, Jett M. Effect of NASA light-emitting diode irradiation on molecular changes for wound healing in diabetic mice. Journal of Clinical Laser Medicine & Surgery 2003; 21(2):67-74. http://dx.doi.org/10.1089/104454703765035484. PMid:12737646
Yamamoto T, Yamamoto N, Azuma S, Todokoro T, Koshima I. Handy thermography for bedside evaluation of pressure ulcer. Journal of Plastic, Reconstructive & Aesthetic Surgery 2013; 66(7):e205-6. http://dx.doi.org/10.1016/j.bjps.2013.02.005. PMid:23481580
Young A, McNaught C. The physiology of wound healing. Surgery 2011; 29(10):475-9.
Zore Z, Boras I, Stanec M, Oresić T, Zore IF. Influence of hormonal status on thermography findings in breast cancer. Acta Clinica Croatica 2013; 52(1):35-42. PMid:23837271.
Agnol MA, Nicolau RA, Lima CJ, Munin E. Comparative analysis of coherent light action (laser) versus non-coherent light (light-emitting diode) for tissue repair in diabetic rats. Lasers in Medical Science 2009; 24(6):909-16. http://dx.doi.org/10.1007/s10103-009-0648-5. PMid:19238507
Andrade RM, Eduardo AC. Methodology for automatic process of the fired ceramic tile’s internal defect using IR images and artificial neural network. Journal of the Brazilian Society of Mechanical Sciences and Engineering 2011; 33(1):67-73. http://dx.doi.org/10.1590/S1678-58782011000100010.
Bernard V, Staffa E, Mornstein V, Bourek A. Infrared camera assessment of skin surface temperature: effect of emissivity. Physica Medica 2013; 29(6):583-91. http://dx.doi.org/10.1016/j.ejmp.2012.09.003. PMid:23084004
Bostock H, Campero M, Serra J, Ochoa JL. Temperaturedependent double spikes in C-nociceptors of neuropathic pain patients. Brain 2005; 128(Pt 9):2154-63. http://dx.doi.org/10.1093/brain/awh552. PMid:15947060
Bronzino JD. Medical devices and systems. Boca Raton: CRC Press; 2006. http://dx.doi.org/10.1201/9781420003864.
Bryant RA, Nix DP. Acute and chronic wounds: current management concepts. 4th ed. St. Louis: Elsevier Mosby; 2012.
Caetano KS, Frade MA, Minatel DG, Santana LA, Enwemeka CS. Phototherapy improves healing of chronic venous ulcers. Photomedicine and Laser Surgery 2009; 27(1):111-8. http://dx.doi.org/10.1089/pho.2008.2398. PMid:19196110
Calado CR, Calado FAR, Caput G, Gomes SC, Andrade RM. Porosity and delamination defect detection in ceramic materials by active infrared thermography and optical digital microscopy. Materials Science Forum 2014; 798-799:671-6. http://dx.doi.org/10.4028/www.scientific.net/MSF.798-799.671.
Christensen J, Matzen LH, Vaeth M, Schou S, Wenzel A. Thermography as a quantitative imaging method for assessing postoperative inflammation. Dento Maxillo Facial Radiology 2012; 41(6):494-9. http://dx.doi.org/10.1259/dmfr/98447974. PMid:22752326
Corazza AV, Jorge J, Kurachi C, Bagnato VS. Photobiomodulation on the angiogenesis of skin wounds in rats using different light sources. Photomedicine and Laser Surgery 2007; 25(2):102-6. http://dx.doi.org/10.1089/pho.2006.2011.PMid:17508845
Datasus. [cited 2012 July 11]. Available from: http://www.datasus.gov.br/.
Erdle BJ, Brouxhon S, Kaplan M, Vanbuskirk J, Pentland AP. Effects of continuous-wave (670-nm) red light on wound healing. Dermatologic Surgery 2008; 34(3):320-5. PMid:18177400.
European Pressure Ulcer Advisory Panel - EPUAP. National Pressure Ulcer Advisory Panel - NPUAP. Treatment of pressure ulcers: quick reference guide. Washington: National Pressure Ulcer Advisory Panel; 2009.
European Wound Management Association - EWMA. Position document: hard-to-heal wounds. A holistic approach. London: MEP Ltd; 2008.
Frize M, Ogungbemile A. Estimating rheumatoid arthritis activity with infrared image analysis. Studies Health Technolology Informactcs 2012; 180:594-8. PMid:22874260.
Garcia A, Siddiqui A. Pressure ulcers: the role of thermography and the need to revisit staging. Ostomy/Wound Management 2012; 58(12):10. PMid:23392647.
Haddad DS, Brioschi ML, Arita ES. Thermographic and clinical correlation of myofascial trigger points in the masticatory muscles. Dento Maxillo Facial Radiology 2012; 41(8):621-9. http://dx.doi.org/10.1259/dmfr/98504520.PMid:23166359
Huang CL, Wu YW, Hwang CL, Jong YS, Chao CL, Chen WJ, Wu YT, Yang WS. The application of infrared thermography in evaluation of patients at high risk for lower extremity peripheral arterial disease. Journal of Vascular Surgery 2011; 54(4):1074-80. http://dx.doi.org/10.1016/j.jvs.2011.03.287. PMid:21784604
Karu TI. Low-power laser therapy. In: Vo-Dinhed T. Biomedical Photonics Handbook. Florida: CRC Press; 2003.
Kateb B, Yamamoto V, Yu C, Grundfest W, Gruen JP. Infrared thermal imaging: a review of the literature and case report. NeuroImage 2009; 47(2, Suppl 2):T154-62. http://dx.doi.org/10.1016/j.neuroimage.2009.03.043. PMid:19332140
Kramer JD, Kearney M. Patient, wound, and treatment characteristics associated with healing in pressure ulcers. Advances in Skin & Wound Care 2000; 13(1):17-24. PMid:11061706.
Lanzafame RJ, Stadler I, Kurtz AF, Connelly R, Peter TA, Brondon P, Olson D. Reciprocity of exposure time and irradiance on energy density during photoradiation on wound healing in a murine pressure ulcer model. Lasers in Surgery and Medicine 2007; 39(6):534-42. http://dx.doi.org/10.1002/lsm.20519. PMid:17659591
Lyder CH. Pressure ulcer prevention and management. Journal of the American Medical Association 2003; 289(2):223-6. http://dx.doi.org/10.1001/jama.289.2.223. PMid:12517234
Minatel DG, Frade MAC, França SC, Enwemeka CS. Phototherapy promotes healing of chronic diabetic leg ulcers that failed to respond to other therapies. Lasers in Surgery and Medicine 2009; 41(6):433-41. http://dx.doi.org/10.1002/lsm.20789. PMid:19588536
Nagase T, Sanada H, Takehara K, Oe M, Iizaka S, Ohashi Y, Oba M, Kadowaki T, Nakagami G. Variations of plantar thermographic patterns in normal controls and non-ulcer diabetic patients: novel classification using angiosome concept. Journal of Plastic, Reconstructive & Aesthetic Surgery 2011; 64(7):860-6. http://dx.doi.org/10.1016/j.bjps.2010.12.003. PMid:21257357
Nakagami G, Sanada H, Iizaka S, Kadono T, Higashino T, Koyanagi H, Haga N. Predicting delayed pressure ulcer healing using thermography: a prospective cohort study. Journal of Wound Care 2010; 19(11):465-6. http://dx.doi.org/10.12968/jowc.2010.19.11.79695. PMid:21135794
Perricone N. How to approach acute and chronic wound healing in the elderly. Wounds 1999; 11(6):145-51.
Rich PB, Dulabon GR, Douillet CD, Listwa TM, Robinson WP, Zarzaur BL, Pearlstein R, Katz LM. Infrared thermography: a rapid, portable, and accurate technique to detect experimental pneumothorax. The Journal of Surgical Research 2004; 120(2):163-70. http://dx.doi.org/10.1016/j.jss.2004.02.026. PMid:15234209
Robson MC, Hill DP, Woodske ME, Steed DL. Wound healing trajectories as predictors of effectiveness of therapeutic agents. Archives of Surgery 2000; 135(7):773-7. http://dx.doi.org/10.1001/archsurg.135.7.773. PMid:10896369
Rocha CLJV. Histophysiology and classification of burn: consequences of local systems and tissue loss in patients burnt. Revista Interdisciplinar de Estudos Experimentais 2009; 1(3):140-7.
Saito H, Omura K, Tateyama M. Alternating monomeric paresis with decreased skin temperature and hyperhidrosis in a case of thoracolumbar myelopathy. Clinical Autonomic Research 2000; 10(2):77-80. http://dx.doi.org/10.1007/BF02279895. PMid:10823339
Sayre EK, Kelechi TJ, Neal D. Sudden increase in skin temperature predicts venous ulcers: a case study. Journal of Vascular Nursing 2007; 25(3):46-50. http://dx.doi.org/10.1016/j.jvn.2007.06.002. PMid:17723909
Skene AI, Smith JM, Doré CJ, Charlett A, Lewis JD. Venous leg ulcers: a prognostic index to predict time to healing. British Medical Journal 1992; 305(6862):1119-21. http://dx.doi.org/10.1136/bmj.305.6862.1119. PMid:1463945
Sousa AP, Santos JN, Reis JA Jr, Ramos TA, Souza J, Cangussú MCT, Pinheiro ALB. Effect of LED phototherapy of three distinct wavelengths on fibroblasts on wound healing: a histological study in a rodent model. Photomedicine and Laser Surgery 2010; 28(4):547-52. http://dx.doi.org/10.1089/pho.2009.2605. PMid:20001321
Tada K, Ikeda K, Tomita K. Effect of polarized light emitting diode irradiation on wound healing. The Journal of Trauma Injury Infection and Critical Care 2009; 67(5):1073-9. http://dx.doi.org/10.1097/TA.0b013e318187ad02. PMid:19680158
Teixeira GGD. Metrological reliability in thermography applied for electrical systems [dissertation]. Belo Horizonte: Universidade Federal de Minas Gerais; 2012.
Vermolen FJ, Javierre E. Computer simulations from a finite-element model for wound contraction and closure. Journal of Tissue Viability 2010; 19(2):43-53. http://dx.doi.org/10.1016/j.jtv.2009.11.003. PMid:20022249
Whelan HT, Buchmann EV, Dhokalia A, Kane MP, Whelan NT, Wong-Riley MTT, Eells JT, Gould LJ, Hammamieh R, Das R, Jett M. Effect of NASA light-emitting diode irradiation on molecular changes for wound healing in diabetic mice. Journal of Clinical Laser Medicine & Surgery 2003; 21(2):67-74. http://dx.doi.org/10.1089/104454703765035484. PMid:12737646
Yamamoto T, Yamamoto N, Azuma S, Todokoro T, Koshima I. Handy thermography for bedside evaluation of pressure ulcer. Journal of Plastic, Reconstructive & Aesthetic Surgery 2013; 66(7):e205-6. http://dx.doi.org/10.1016/j.bjps.2013.02.005. PMid:23481580
Young A, McNaught C. The physiology of wound healing. Surgery 2011; 29(10):475-9.
Zore Z, Boras I, Stanec M, Oresić T, Zore IF. Influence of hormonal status on thermography findings in breast cancer. Acta Clinica Croatica 2013; 52(1):35-42. PMid:23837271.
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