Department of Dermatology and Allergology, University Hospital Augsburg, Augsburg, Germany.
Institute of Mathematics, University of Augsburg, Augsburg, Germany.
J Eur Acad Dermatol Venereol. 2024 Jan;38(1):223-231. doi: 10.1111/jdv.19496. Epub 2023 Sep 19.
Chronic ulcers, especially venous leg ulcers, are a major burden on the healthcare system. To date there are only few non-invasive established procedures for evaluation of blood perfusion in wounds. Dynamic optical coherence tomography (D-OCT) provides images of the skin's superficial vascularisation.
This study aims to investigate if and how the D-OCT measurement of chronic wounds can provide new information about the vascularisation during the healing process.
We examined 16 venous ulcers over 16 weeks and evaluated the vessel morphology and density using D-OCT at the wound bed, borders, two centimetres adjacent to the wound und at non-ulcerated skin on the contralateral leg.
In D-OCT scans clumps were unique and the most common vessel type in the wound area of venous ulcers, whereas lines and serpiginous vessels were the most common in non-ulcerated skin. At the wound border mottle and cluster patterns occurred more frequently. Healthy skin showed a significant increase of mesh pattern. Vessel density significantly increased at the wound area compared to non-ulcerated skin. During the healing process the wound border showed the most vascular changes while only an increase in curves was observed in the wound centre. Non-healing wounds had fewer dots and blobs at the borders, fewer dots, coils, clumps, lines and serpiginous vessels at the centre and fewer dots in adjacent skin. Temperature analysis showed higher temperatures in non-ulcerated skin, followed by the wound margin and centre. Non-healing wounds showed the lowest temperatures in the wound centre.
These results highlight the non-invasive use of D-OCT for the examination and monitoring of wound healing in chronic venous ulcers. D-OCT imaging of blood vessels may offer the potential to detect disorders of wound healing at an early stage, differentiate ulcers of different genesis and to tailor more individualized, patient-oriented therapy.
慢性溃疡，尤其是静脉性腿部溃疡，给医疗保健系统带来了巨大负担。迄今为止，仅有少数几种非侵入性的既定方法可用于评估伤口的血液灌注。动态光学相干断层扫描（D-OCT）可提供皮肤浅层血管化的图像。
本研究旨在探讨 D-OCT 对慢性伤口的测量是否以及如何提供有关愈合过程中血管化的新信息。
我们检查了 16 例静脉性溃疡，在 16 周内使用 D-OCT 评估了伤口床、边界、距伤口两厘米处以及对侧腿未溃疡皮肤处的血管形态和密度。
在 D-OCT 扫描中，簇是静脉性溃疡伤口区域中唯一且最常见的血管类型，而线状和蛇形血管则是未溃疡皮肤中最常见的血管类型。在伤口边界处，斑点和簇状模式更为常见。健康皮肤的网格模式显著增加。与未溃疡皮肤相比，伤口区域的血管密度显著增加。在愈合过程中，伤口边界显示出最多的血管变化，而仅在伤口中心观察到曲线增加。未愈合的伤口在边界处的点和团块较少，在中心处的点、线圈、簇、线和蛇形血管较少，在相邻皮肤处的点较少。温度分析显示，未溃疡皮肤的温度较高，其次是伤口边缘和中心。未愈合的伤口在伤口中心处的温度最低。
这些结果突出了 D-OCT 对慢性静脉性溃疡伤口愈合的检查和监测的非侵入性应用。血管的 D-OCT 成像可能有潜力在早期检测到伤口愈合障碍，区分不同病因的溃疡，并为更个体化、以患者为中心的治疗提供依据。
