CASE STUDY SERIES: USING SNAPSHOTNIR FOR EARLY IDENTIFICATION & PREVENTION OF ULCERS
Charles Andersen, MD and Homer-Christian Reiter, BSc, Research Coordinator
Chief of Wound Care Service at Madigan Army Medical Center
CASE 1: Focused identification of sheer force and pressure in advance of ulcer formation
PATIENT DETAILS
A 70-year-old female with bilateral Charcot deformity and diabetic neuropathy.
CASE DETAILS
The patient has bilateral trans-metatarsal amputation due to complications from diabetic foot disease and experiences bilateral foot friction and pressure when walking. The patient is currently being followed for maintenance foot care to prevent ulceration. She has been urged to get fitted for custom shoes and orthotics to enhance offl oading. On routine visits, SnapshotNIR imaging is utilized to identify pressure points that require footwear modifi cation.
OBSERVATIONS
The patient’s feet are often heavily callused and must be routinely debrided. SnapshotNIR images in April show increased oxygenation over her fifth metatarsophalangeal joint, suggesting increased perfusion due to an inflammatory tissue response from pressure and shear forces. The hemoglobin view of the same image set confirms this observation with the elevated values for oxyhemoglobin over the joint compared to the surrounding tissues.
Focused offloading and footwear modification were monitored using Snapshot imaging. Decreases in inflammation correlated with improved offloading and a reduction in pressure and shear forces. Early detection and intervention in areas of increased inflammation identified with Snapshot prevented foot ulcer formation.
OUTCOME
The patient's wound has completely healed, and the patient is ambulatory with a cane. As the patient also has chronic venous insufficiency with secondary lymphedema, he was referred to the lymphedema clinic for further treatment.
CASE 2: Focused Offloading to Prevent Recurrent Ulcers
PATIENT HISTORY
76-year-old male, with Type 2 Diabetes Mellitus, bed-bound due to morbid obesity.
CASE DETAILS
The patient, who spends most his day in bed, has developed ulcers on his left foot at the lateral 5th metatarsophalangeal joint. Both feet are positioned in bed the same way, so his right foot was imaged with SnapshotNIR to rule out potential injury to this foot even though no ulceration was present.
OBSERVATIONS
Due to the patient’s lack of mobility, the clinic team was aware that he would be prone to pressure injuries. This prompted the team to capture tissue oxygenation images with the SnapshotNIR device to assess tissue health.
With the NIRS imaging, we were able to observe a moderate increase in oxygenation over his 5th metatarsophalangeal joint (MTPJ) when compared to his surrounding tissues. The hemoglobin view images also identified a contrast in values of oxyhemoglobin when comparing the MTPJ with surrounding tissues.
IMPACT
The Snapshot images identified areas of increased oxygenation and tissue perfusion suggesting significant inflammation in his right foot lateral 5th metatarsophalangeal joint, matching the wound location on his left foot. These changes are reflective of tissue trauma due to pressure forces. Early identification of an area at risk for pressure injury allowed intervention with enhanced pressure redistribution efforts including repositioning and increased foot padding avoided further tissue damage and prevented ulceration.
Near-infrared spectroscopy (NIRS) imaging can positively impact the care of a patient at risk for pressure injury. Snapshot imaging allows us to see early stages of tissue inflammation (potential deep tissue injury) and proactively optimize pressure management protocols in an effort to prevent tissue ulceration. At serial follow-up, NIRS imaging can be used to assess that the modification of the care plan has decreased the inflammation thereby protecting the tissue from injury. With ongoing NIRS assessment and early intervention with enhanced pressure redistribution efforts, we were able to successfully prevent new ulceration in this patient.
Notice the areas of increased oxygenation indicating significant inflammation in patient’s right foot lateral to the 5th metatarsophalangeal joint. Note the oxyhemoglobin markers in the lower right pane of the hemoglobin view image.
“SnapshotNIR images support the proactive identification tissue at risk prior to ulceration and take early and appropriate steps to prevent this tissue damage.”