ASK THE EXPERT: DR. JONATHAN ARNOLD
ASK THE EXPERT
Jonathan Arnold, MD, ABPM-UHM, CWS-P is a wound care and treatment therapy specialist with a focus on hyperbaric medicine. We spoke to Dr. Arnold about how he uses the innovative SnapshotNIR in his wound care practice.
In the past, how were your patients tested and assessed for lower extremity vascularization?
In the outpatient setting, the most common non-invasive screening test is ABI (Ankle Brachial Index). We also use TCOM (Transcutaneous Oxygen Measurement) and Laser Doppler skin perfusion pressure.
What would you say is the major drawback or limitation to some of those tests?
A good example would be the ABI. Many patients have calcified vessels, which can cause a falsely elevated ABI. These results can be misleading, suggesting blood flow to the area is acceptable when it is actually inadequate. These tests can also be time-consuming and technically difficult. Many times, these test values vary depending on the person performing the test.
Another example of a test with a numerical result is TCOM. In the TCOM scenario, the skin has a tremendous blood supply and so you could have a fairly normal TCOM reading but the underlying tissue could be relatively ischemic. By design, the TCOM lead warms the skin. In general, the warming increases blood flow to the area of lead placement, which can cause the final test value to overstate perfusion.
How would you say that SnapshotNIR has changed the way that wounds can be tested and tracked
SnapshotNIR is quickly and easily administered. Compared to the non-invasive tests we’ve mentioned so far, the amount of diagnostic information gained in a relatively short time is tremendous!
Many non-invasive tests take 30-60 minutes to perform. The initial SnapshotNIR image takes 3-5 minutes with serial images taking even less time. This makes baseline and serial assessments more practical. Another important factor is that SnapshotNIR is much more reliable from operator to operator.
In your practice, what types of therapies have benefited from using SnapshotNIR?
We’ve used SnapshotNIR in a wide variety of situations. This imaging technology helps us understand how blood is flowing to and from the wound area. This information helps us decide if more detailed testing is needed and how patients are responding to therapies. Our most common chronic wounds are diabetic foot ulcers and venous leg ulcers. We’ve also looked at chronic post-op wounds that may involve disruption of primary blood supply.
What would you say is the most interesting or positive case you’ve had using SnapshotNIR?
Two specific cases come to mind. One of our patients had a skin cancer excised from the left side of his nose. The ENT surgeon was concerned about blood flow to the flap used to cover the excision defect. Not only is the application of a TCOM lead in this area difficult, but the process may also further compromise blood flow to the flap. In this case, we use SnapshotNIR to obtain valuable information quickly without causing any problems to an already compromised flap.
The second case was a pre and post-revascularization. Many times, a vascular surgeon or invasive cardiologist will open the blood vessel to supply the wound area. SnapshotNIR can be used to determine if wound area blood supply has improved. Based on this information, we are able to determine if further vascular intervention is needed
I would like to add one additional thought. At this time of increased attention to infection control, it’s important to note that the SnapshotNIR device does not come into contact with the patient’s wound area. So, in summary, we can quickly and safely gain valuable clinical information at the point-of-care.
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