Dalicho Valerie, Straube Tina, Kelly Kathrin, Larsen Beke, Wünsch Lutz, Lindert Judith
Paediatric Burn Center Lübeck, Department of Paediatric Surgery, University Hospital Lübeck, Lübeck, Germany.
Department of Paediatric Surgery, University Hospital Rostock Rostock, Germany.
Innov Surg Sci. 2024 Jun 12;9(2):83-91. doi: 10.1515/iss-2023-0066. eCollection 2024 Jun.
Deep thermal injuries are among the most serious injuries in childhood, often resulting in scarring and functional impairment. However, accurate assessment of burn depth by clinical judgment is challenging. Optical coherence tomography (OCT) provides structural images of the skin and can detect blood flow within the papillary plexus. In this study, we determined the depth of the capillary network in healthy and thermally injured skin and compared it with clinical assessment.
In 25 children between 7 months and 15 years of age (mean age 3.5 years (SD±4.14)) with thermal injuries of the ventral thoracic wall, we determined the depth of the capillary network using OCT. Measurements were performed on healthy skin and at the center of the thermal injury (16 grade IIa, 9 grade IIb). Comparisons were made between healthy skin and thermal injury.
The capillary network of the papillary plexus in healthy skin was detected at 0.33 mm (SD±0.06) from the surface. In grade IIb injuries, the depth of the capillary network was 0.36 mm (SD±0.06) and in grade IIa injuries 0.23 mm (SD±0.04) (Mann-Whitney U test: p<0.001). The overall prediction accuracy is 84 %.
OCT can reliably detect and differentiate the depth of the capillary network in both healthy and burned skin. In clinical IIa wounds, the capillary network appears more superficial due to the loss of the epidermis, but it is still present in the upper layer, indicating a good prognosis for spontaneous healing. In clinical grade IIb wounds, the papillary plexus was visualized deeper, which is a sign of impaired blood flow.
深度热烧伤是儿童最严重的损伤之一，常导致瘢痕形成和功能障碍。然而，通过临床判断准确评估烧伤深度具有挑战性。光学相干断层扫描（OCT）可提供皮肤的结构图像，并能检测乳头层血管丛内的血流。在本研究中，我们确定了健康皮肤和热损伤皮肤中毛细血管网的深度，并将其与临床评估结果进行比较。
对25例年龄在7个月至15岁（平均年龄3.5岁（标准差±4.14））的胸腹壁热损伤儿童，使用OCT确定毛细血管网的深度。在健康皮肤和热损伤中心（16例Ⅱa度，9例Ⅱb度）进行测量。对健康皮肤和热损伤进行比较。
健康皮肤乳头层血管丛的毛细血管网在距表面0.33 mm（标准差±0.06）处被检测到。在Ⅱb度损伤中，毛细血管网深度为0.36 mm（标准差±0.06），在Ⅱa度损伤中为0.23 mm（标准差±0.04）（曼-惠特尼U检验：p<0.001）。总体预测准确率为84 %。
OCT能够可靠地检测和区分健康皮肤和烧伤皮肤中毛细血管网的深度。在临床Ⅱa度伤口中，由于表皮缺失，毛细血管网网显得得更浅表，但仍存在于上层，这表明自发愈合的预后良好。在临床Ⅱb度伤口中，乳头层血管丛显示得更深，这是血流受损的迹象。
