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Microvascular blood flow in scalds in children and its relation to duration of wound healing: A study using laser
Robin Mirdell1, Fredrik Iredahl1, Folke Sjöberg2
1Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
Insights
Microvascular perfusion in pediatric scalds, measured by laser speckle contrast imaging (LSCI), shows distinct healing patterns. Early perfusion on day 4 best predicts burn healing duration and severity.
Area of Science:
- Pediatric burn care
- Wound healing research
- Medical imaging techniques
Background:
- Microvascular perfusion changes in pediatric scalds impact healing outcomes.
- Laser Doppler imaging has predicted the need for surgical intervention (excision and grafting).
- Detailed day-to-day perfusion changes in early scald healing remain understudied.
Purpose of the Study:
- To measure microvascular perfusion changes in pediatric scalds over three weeks post-injury using laser speckle contrast imaging (LSCI).
- To correlate perfusion patterns with healing duration in a conservative treatment model delaying surgical decisions to day 14.
- To investigate the relationship between perfusion dynamics and burn severity.
Main Methods:
- Laser speckle contrast imaging (LSCI) was used to measure perfusion in 34 pediatric scald patients.
- Measurements were taken at regular intervals from 6 hours post-injury until complete reepithelialization or surgery.
- Healing duration was defined as the time to complete reepithelialization.
Main Results:
- Lower perfusion between 6 and 96 hours post-injury correlated with longer healing times, most strongly at 72-96 hours.
- Healed burns (within 14 days) exhibited high initial perfusion, followed by a peak and gradual decrease.
- Perfusion patterns, including maximum perfusion and time-to-peak, varied with burn severity; excisional wounds showed less initial perfusion and a steady decline.
Conclusions:
- Pediatric scald perfusion exhibits characteristic patterns linked to healing duration and burn severity.
- The most significant differentiation between wounds of varying severity occurs on day 4 post-injury.
- Perfusion measurement on the fourth day is recommended for assessing burn depth and predicting healing outcomes.
Background:
Microvascular perfusion changes in scalds in children during the first weeks after injury is related to the outcome of healing, and measurements of perfusion, based on laser Doppler imaging, have been used successfully to predict the need for excision and grafting. However, the day-to-day changes in perfusion during the first weeks after injury have not to our knowledge been studied in detail. The aim of this study, based on a conservative treatment model where excision and grafting decisions were delayed to day 14 after injury, was to measure changes in perfusion in scalds using laser speckle contrast imaging (LSCI) during the first three weeks after injury.
Methods:
We measured perfusion with LSCI in 34 patients at regular intervals between 6h after injury until complete reepithelialization or surgery. Duration of healing was defined as the time to complete reepithelialization.
Results:
Less perfusion, between 6 and 96h after injury, was associated with longer duration of healing with the strongest association occurring between 72 and 96h. Burns that healed within 14 days had relatively high initial perfusion, followed by a peak and subsequent slow decrease. Both the maximum perfusion and the time-to-peak were dependent on the severity of the burn. Burns that needed excision and grafting had less initial perfusion and a gradual reduction over time.
Conclusion:
The perfusion in scalds in children shows characteristic patterns during the first weeks after injury depending on the duration of wound healing, the greatest difference between wounds of different severity being on the 4th day. Perfusion should therefore preferably be measured on the fourth day if it is to be used in the assessment of burn depth.
