The use of medical hyperspectral technology to evaluate microcirculatory changes in diabetic foot ulcers and to predict clinical outcomes.
OBJECTIVE
Foot ulceration is a serious complication of diabetes, and new techniques that can predict wound healing may prove very helpful. We tested the ability of medical hyperspectral technology (HT), a novel diagnostic scanning technique that can quantify tissue oxy- and deoxyhemoglobin to predict diabetic foot ulcer healing.


METHODS
Ten type 1 diabetic patients with 21 foot ulcer sites, 13 type 1 diabetic patients without ulcers, and 14 nondiabetic control subjects were seen up to 4 times over a 6-month period. HT measurements of oxyhemoglobin (HT-oxy) and deoxyhemoglobin (HT-deoxy) were performed at or near the ulcer area and on the upper and lower extremity distant from the ulcer. An HT healing index for each site was calculated from the HT-oxy and -deoxy values.


RESULTS
Hyperspectral tissue oxygenation measurements observed changes in tissue immediately surrounding the ulcer when comparing ulcers that heal and ulcers that do not heal (P < 0.001). The sensitivity, specificity, and positive and negative predictive values of the HT index for predicting healing were 93, 86, 93, and 86%, respectively, when evaluated on images taken at the first visit. Changes in HT-oxy among the three risk groups were noted for the metatarsal area of the foot (P < 0.05) and the palm (P < 0.01). Changes in HT-deoxy and the HT healing index were noted for the palm only (P < 0.05 and P < 0.01, respectively).


CONCLUSIONS
HT has the capability to identify microvascular abnormalities and tissue oxygenation in the diabetic foot and predict ulcer healing. HT can assist in the management of foot ulceration.
Khaodhiar
Lalita
L
Joslin-Beth Israel Deaconess Foot Center and Microcirculation Laboratory , Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
Dinh
Thanh
T
Schomacker
Kevin T
KT
Panasyuk
Svetlana V
SV
Freeman
Jenny E
JE
Lew
Robert
R
Vo
Tiffany
T
Panasyuk
Alexander A
AA
Lima
Christina
C
Giurini
John M
JM
Lyons
Thomas E
TE
Veves
Aristidis
A
D000328:Adult; D000368:Aged; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D003925:Diabetic Angiopathies / Q000175:diagnosis; D017719:Diabetic Foot / Q000175:diagnosis / Q000503:physiopathology*; D003929:Diabetic Neuropathies / Q000175:diagnosis; D005260:Female; D016523:Foot Ulcer / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008297:Male; D013677:Medical Laboratory Science / Q000379:methods*; D008833:Microcirculation / Q000502:physiology*; D036641:Microscopy, Fluorescence, Multiphoton / Q000379:methods; D008875:Middle Aged; D010101:Oxygen Consumption; D012016:Reference Values; D012867:Skin / Q000098:blood supply; D016896:Treatment Outcome; D014945:Wound Healing