Childs C, Siraj M R, Fair F J, Selvan A N, Soltani H, Wilmott J, Farrell T
Professor of Clinical Science, Midwifery Researcher, Professor of Maternal and Infant Health, Centre for Health and Social Care Research, Sheffield Hallam University, Montgomery House, 32 Collegiate Crescent, Sheffield.
ST7 Obstetrics and Gynaecology, Consultant, Jessop Wing, Sheffield Teaching Hospital NHS Trust, Tree Root Walk, Sheffield.
J Wound Care. 2016 Sep;25(9):499-512. doi: 10.12968/jowc.2016.25.9.499.
OBJECTIVE: To develop and refine qualitative mapping and quantitative analysis techniques to define 'thermal territories' of the post-partum abdomen, the caesarean section site and the infected surgical wound. In addition, to explore women's perspectives on thermal imaging and acceptability as a method for infection screening. METHOD: Prospective feasibility study undertaken at a large University teaching hospital, Sheffield UK. Infrared thermal imaging of the abdomen was undertaken at the bedside on the first two days after elective caesarean section. Target recruitment: six women in each of three body mass index (BMI) categories (normal, 18.5-24.9 kg/m²; overweight 25-29.9 kg/m²; obese ≥30 kg/m²). Additionally, women presenting to the ward with wound infection were eligible for inclusion in the study. Perspectives on the use of thermal imaging and its practicality were also explored via semi-structured interviews and analysed using thematic content analysis. RESULTS: We recruited 20 women who had all undergone caesarean section. From the booking BMI, eight women were obese (including two women with infected wounds), seven women were overweight and five women had a normal BMI. Temperature (ºC) profiling and pixel clustering segmentation (hierarchical clustering-based segmentation, HCS) revealed characteristic features of thermal territories between scar and adjacent regions. Differences in scar thermal intensity profiles exist between healthy scars and infected wounds; features that have potential for wound surveillance. The maximum temperature differences (∆T) between healthy skin and the wound site exceed 2º C in women with established wound infection. At day two, two women had a scar thermogram with features observed in the 'infected' wound thermogram. CONCLUSION: Thermal imaging at early and later times after caesarean birth is feasible and acceptable. Women reported potential benefits of the technique for future wound infection screening. Thermal intensity profiling and HCS for pixel cluster dissimilarity between scar and adjacent healthy skin has potential as a method for the development of techniques targeted to early infection surveillance in women after caesarean section.
目的：开发并完善定性映射和定量分析技术，以界定产后腹部、剖宫产切口部位及感染手术伤口的“热区”。此外，探究女性对热成像作为感染筛查方法的看法及可接受性。 方法：在英国谢菲尔德的一家大型大学教学医院进行前瞻性可行性研究。在择期剖宫产术后的头两天，于床边对腹部进行红外热成像。目标招募对象：三个体重指数（BMI）类别（正常，18.5 - 24.9 kg/m²；超重，25 - 29.9 kg/m²；肥胖，≥30 kg/m²）中各六名女性。此外，因伤口感染入住病房的女性也符合纳入该研究的条件。还通过半结构化访谈探讨了对热成像使用的看法及其实用性，并采用主题内容分析法进行分析。 结果：我们招募了20名均接受过剖宫产的女性。根据预登记的BMI，八名女性肥胖（包括两名伤口感染女性），七名女性超重，五名女性BMI正常。温度（℃）剖面图和像素聚类分割（基于层次聚类的分割，HCS）揭示了瘢痕与相邻区域之间热区的特征。健康瘢痕与感染伤口之间的瘢痕热强度剖面图存在差异；这些特征具有伤口监测的潜力。已确诊伤口感染的女性中，健康皮肤与伤口部位之间的最大温差（∆T）超过2℃。在术后第二天，两名女性的瘢痕热像图具有在“感染”伤口热像图中观察到的特征。 结论：剖宫产术后早期和后期进行热成像可行且可接受。女性报告了该技术在未来伤口感染筛查方面的潜在益处。瘢痕与相邻健康皮肤之间的热强度剖面图和用于像素聚类差异分析的HCS有潜力作为一种方法，用于开发针对剖宫产术后女性早期感染监测的技术。
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