USING SNAPSHOTNIR AND A WOUND BIOLOGIC TO PRESERVE A LIMB
Dr. Adam Landsman, DPM, PhD
Dr. Landsman is a Podiatrist in the Department of Orthopaedic Surgery at Massachusetts General Hospital, providing expert care for foot and ankle conditions. A board-certified foot surgeon, he serves as an Assistant Professor of Orthopaedics at Harvard Medical School.
CASE HISTORY
43-year-old male, frequently homeless, with poorly controlled Type I diabetes presented at the clinic with a large diabetic foot ulcer on the plantar aspect of the foot. Following clinical evaluation, a conventional course of treatment was initiated. The wound continued to deteriorate with standard treatment until it measured 8x7 cm. At this point, insurance approval was obtained to proceed with a cryopreserved split-thickness skin allograft. The large eschar over the ulcer, as seen in Figure 1, was removed using sharp and enzymatic debridement until a pink granular bed was present. The patient received three applications of the skin substitute Theraskin® (Misonix). He responded to this therapy with the wound fully closing after 10 weeks of initial application.
OBSERVATIONS AND ACTIONS
With the black eschar over the wound, there was no visual indication of the depth of the necrosis. Using SnapshotNIR, we were able to image through the edges of the eschar as it was slowly chipped away. The information captured with the device was used to gauge the depth of the ischemic tissue. The images indicated good tissue oxygenation at the edge of the eschar with each progressive debridement where a few millimeters were removed during each session. With the successive debridement, a fibrous-looking wound bed was uncovered. SnapshotNIR was next used to confirm that the circulation and tissue oxygenation in and around the wound bed was at a level that would likely support the successful application of the skin substitute. The patient received three applications of the skin substitute Theraskin® (Misonix). He responded to this therapy with the wound fully closing after 10 weeks of initial application
“Imaging the wound with NIRS showed sufficient oxygenation of the peri-wound tissues indicating blood flow. With this additional insight into the tissue viability, I was confident that the application of the skin substitute would likely close the wound.”
For more information on NIRS image interpretation in wound healing, please refer to Landsman, A. Visualization of wound healing progression with near-infrared spectroscopy: a retrospective study. Wounds. 2020; 32(10): 265-271.
