How 3D scanning supports chronic wound healing.

The treatment and management of chronic wounds is considerably “complicated” and naturally “dynamic”. Attention and support must be provided to inner-body and external parameters that nurture an optimal wound healing environment. To support this, the CQUIN recommends nurses (and other health care professionals) to monitor, assess and document wounds and consequent healing responses. However, existing monitoring and assessment techniques: cotton tip applicators, acetate methods, microscopic or analytical tissue sampling methods are considered somewhat invasive.

For a non-invasive solution to capturing wound measurements, we propose our 3D wound scanner. Our proprietary software has not only been designed to capture the length, width and volume of a wound, but has been purposefully designed to identify colonies of harmful bacteria. Cadscan’s 3D wound scanner offers quantifiable comparators to support decision making (dressings, treatments to use) and map the patient’s wound healing process

THE SKIN

Skin is considered one of the largest and most complicated organs of the human body. As part of the integumentary system, the skin plays a crucial role in protecting the body against the external physical environment. This organ facilitates: sensation, temperature regulation, moisture transmission, vitamin production and immune defence.

WOUND FORMATION

Wounds are formed by a breakage to the skin and/or underlying tissue, typical causes include: chemicals, cuts, shear force, pressure etc. Post-trauma, the skin’s function as a protective barrier is compromised thus increasing its susceptibility to microbial infections.

Acute wounds: are formed as a result of tissue damaged by trauma, this may be intentional (surgery) or accidental (chemicals, cuts). Typically, acute wounds are expected to normally progress through all phases of wound healing, resulting in wound closure.

Chronic wounds: typically occur as diabetic foot ulcers, venous leg ulcers and pressure ulcers. Chronic leg and foot ulcers are most likely to occur in patients with diabetic foot ulcers and venous leg ulcers. This is commonly attributed to venous insufficiency, prolonged pressure and neuropathy. These wounds do not progress through the normal healing process in a typical time frame: ideally, 70% of venous leg ulcers should take between 12-16 weeks to heal, but a significant proportion fail to do so, and carry an elevated risk of infection.

Wound healing begins post-tissue injury. The healing time-span is often dependent on the wound origin, tissue structure, cell lineages, extent of trauma etc as well as some external parameters (dressings, pressure).

 

THE SOCIO-ECONOMIC IMPACT OF WOUNDS.

Between 2012 and 2013, Guest et al investigated the “Health economic burdens that wounds impose on the National Health service” inadvertently creating a nationwide catalyst for change. Data from their report suggests, the NHS managed an estimated 2.2 million wounds at a cost £5.3 billion. At an operational level: a shortage of specialists, poor diagnosis and variable standards of care have contributed to some of the challenges experienced in the provision of wound care. These issues are further  exacerbated by strategic challenges in the reduced provision of care and the strained commissioning of services evident across all government platforms.

Difficulty in the provision of wound care often contributes to excessive costs, prolonged hospital stay, risk of acquiring other hospital-acquired infections, delayed healing and an overall poorer quality of life for the patient. Wound care providers are likely to experience an increased strain in the provision of care as a result of an ageing population, increased rate of complex and chronic conditions amongst other societal factors.

The costs of managing chronic wounds are often far greater to treating a healing wound, and often require a greater number of resources. For labour, chronic wounds require 20% and 104% more practice and community nurse visits. When considering expenditure: costs are 135% greater.

From a wider socio-economic perspective, the World Health Organisation have also produced reports about the global antimicrobial resistance. The resistance threatens effective prevention and treatment of an increasing range of infections caused by bacteria, parasites, viruses and fungi. Increased antimicrobial resistance has a direct impact on the management of wounds. According to wound source, in the management and treatment of chronic wounds, “bacterial colonisation, biofilm production and infections are huge global problems”. These  issues are exacerbated by the complexity of chronic wounds that house multiple bacterial species.

3D scanning to support wound care.

As socio-economic pressures in the UK continue to increase, 3D scanning technology could offer some much needed relief in the provision of wound care treatment and management. Here are a few ways in which 3D scanning technology could support wound healing:

Non-invasive: Cadscan’s 3D scanner is a non-contact, non-invasive tool for acquiring wound measurements (length, width and volume) and bacterial presence. By analysing three dimensional interpretations of data, health professionals can avoid any damage to surrounding tissue, which is particularly helpful during oncological investigations. Unlike biopsies which are commonly associated with scar development and pain, the 3D wound scanner is a non-contact, non-invasive tool designed to support real-time decision making at the point of care.

 

Data:  The 3D wound scanner captures and quantifies the wound’s progress over a select period of time. Data captured includes: wound size, volume, temperature, wound position and the presence of necrotic tissue, exudate etc. By continuously capturing the wound’s progress, nurses are equipped with an in-depth, quantifiable understanding of each patient’s unique healing process to inform current and future decision making. Health professionals can combine this data, best-practice treatment and personal judgement to inform clinical decisions at the point of care. Data collated is also likely to be shared across multi-disciplinary teams who may benefit from a unique understanding of the wound and/or use this data to inform follow-up treatment and procedures. Historical data captured by the 3D wound scanner is also integral to supporting and predicting the likelihood of a wound healing, the healing trajectory and the wound outcome.

 

Accuracy: According to the nursing centre “all two dimensional measurement techniques provide only an estimate of the actual wound area” implying existing techniques are only capable of providing estimates rather than “actual” area measurements. Comparatively, 3D wound scanners are emerging as an accurate, reliable and feasible method of capturing and evaluating the wound’s progress. By capturing any changes (to the millimetre) even the smallest deterioration and progress can be captured to inform treatment decisions. Furthermore, by identifying early signs of non-healing, clinicians can effectively avoid many months of ineffective care thus create significant savings and limit invasive solutions.

 

Bacterial presence: Numerous articles exploring bacterial toxins and wound healing state, the average human being harbours at least 200 species of bacteria. This implies when the skin experiences a trauma or disease (chronic illness), bacteria will also be present on the wound. Important considerations when assessing the wound include, bacterial: contamination, colonisation and infection.  Our multi-spectral imaging device has been purposefully designed to illuminate colonies of harmful bacteria including pseudomonas at the point of care.

 

3D scanner: By capturing accurate 3D wound data, health professionals can easily monitor changes in the volume and tissue structure more accurately and avoid limitations in written explanations e.g. describing texture, form and shape to evaluate wound appearance and topography.

 

We propose our tablet-PC based multi-spectral imaging device designed to quickly capture wound volume and bacterial presence. The system has been purposefully designed to support nurses in wound assessments, documentation and decision making. The software will analyse and document the wound, in turn supporting decision makers to make best-practice treatment decisions. We’re proposing a non-invasive, easy-to-use, portable system purposefully designed to support community and/or practice nurses with wound care.

 

For more information on our 3D wound scanner, contact us directly at info@cad-scan.co.uk

 

  1. Robert G. Frykberg and Jaminelli Banks, Challenges in the treatment of chronic wounds, 2015
  2. World Health Organisation, antimicrobial resistance, global report on surveillance, 2014
  3. Wound Source, multidrug-resistant organisms in wound management: state of the science, February 27th 2018.
  4. Rijswijk, Lia Van, wound wise: measuring wounds to improve outcomes, August 2013, Volume: 113, Number 8

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