title: Optical coherence tomography: a reliable alternative to invasive histological assessment of acute wound healing in human skin?
abstract: BACKGROUND
  Gold-standard assessment of acute wound healing has traditionally been through histological analysis of biopsied tissue. However, this process is invasive with recognized side-effects. Optical coherence tomography (OCT) is a noninvasive technique generating high-resolution real-time images of cutaneous architecture.
  
  
  OBJECTIVE
  To compare OCT with histological assessment of in vivo acute wound healing and ascertain the level of agreement between modalities for measurement of defined cutaneous structures.
  
  
  METHODS
  Punch biopsies (5 mm) were harvested from 50 healthy volunteers. Wounds healed by secondary intention until they were re-excised 7, 14, 21 or 28 days later depending on random group allocation. Wounds were assessed weekly for 6 weeks using OCT and compared with histological findings derived from time-matched biopsies. Dimensions of four cutaneous structures were measured using both modalities and the level of agreement was established by Bland-Altman analysis. The mean greyscale value (MGV) of the upper reticular dermis was derived from OCT images at all time points.
  
  
  RESULTS
  Both techniques showed anatomical congruity in normal and wounded skin with correlating architectural changes associated with inflammatory, proliferative and remodelling wound healing phases. MGV was significantly increased 6 weeks after wounding (P = 0·001) and may represent a novel measure of wound fibrosis. Despite good association of histomorphometric values with low but consistent bias (range -4·181 to 0·431 μm), Bland-Altman plots demonstrated poor agreement between OCT and histology.
  
  
  CONCLUSIONS
  Optical coherence tomography enabled accurate assessment of healing tissue comparable with histological analysis of biopsy specimens. This noninvasive tool is highly suited to wound assessment and may represent a diagnostic alternative to punch biopsies.
authors: Plastic and Reconstructive Surgery Research, Manchester Institute of Biotechnology (MIB), University of Manchester, 131 Princess Road, Manchester, M1 7ND, U.K; University Hospital of South Manchester NHS Foundation Trust, Wythenshawe Hospital, Southmoor Road, Manchester, M23 9LT, U.K; School of Materials, University of Manchester, Manchester, M13 9PL, U.K.
authors: N S
authors: NS
authors: Greaves
authors: B
authors: B
authors: Benatar
authors: S
authors: S
authors: Whiteside
authors: T
authors: T
authors: Alonso-Rasgado
authors: M
authors: M
authors: Baguneid
authors: A
authors: A
authors: Bayat
mesh_terms: D000328:Adult; D001707:Biopsy, Needle; D049109:Cell Proliferation / Q000502:physiology; D005260:Female; D005355:Fibrosis / Q000473:pathology; D064368:Healthy Volunteers; D006801:Humans; D007249:Inflammation / Q000473:pathology; D008297:Male; D018919:Neovascularization, Physiologic / Q000502:physiology; D012867:Skin / Q000473:pathology*; D041623:Tomography, Optical Coherence; D014945:Wound Healing / Q000502:physiology*