Ask the Experts

Every 20 seconds, somewhere around the world someone loses their leg because of diabetes.

Critical limb ischemia (CLI) in diabetic patients is increasing drastically worldwide and is already recognized as a major health issue. CLI frequently leads to major amputations. One key to preventing limb loss is to restore a good vascularization to the foot, usually through endovascular means. No consensual indicator is currently available to estimate if the limb revascularization will be sufficient or not to prevent amputation, and to help physicians decide if they should be more aggressive during endovascular procedures.

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Wounds come in all shapes and sizes, with a myriad of underlying casualties or impactors (eg, diabetes). Wound patients are complex, and often clinical signs and symptoms can be subcutaneous and not readily visible to the human eye.

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Spectral imaging offers a technological solution to help better understand this patient population, their wounds and the outcomes of treatment. This technology also offers significant potential in the preventative area by allowing the identification of tissue at risk, helping clinicians eliminate preventable amputations and provide better patient outcomes.

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Perfusion is the means by which blood provides nutrients and removes cellular waste. Adequate tissue perfusion is required to maintain healthy vital tissue.

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The emergence of new imaging technologies offer access to high quality imaging and images pre- and post-treatment. These capabilities can be used to analyze tissue perfusion in limbs, and correlate those imaging parameters to positive clinical outcomes, such as wound healing, thus creating a useful tool to guide physicians in daily practice.

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Differences between tissue perfusion assessments performed before and after revascularization for example could be used to estimate the quality of the revascularization and predict wound healing and limb salvage. This would revolutionise the management of this patient population and provide better insight into the care pathways provided.

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The availability of oxygen to cells in the wound and the presence of adequate blood flow are important factors to the healing process. Oxygen plays a critical role in the formation of collagen, the growth of new capillaries, and the control of infection. Perfusion and delivery of oxygen to tissue are closely related. Scientific studies have clarified how oxygen and blood flow influence healing.

Tissue perfusion assessment is a critical component to successful wound healing.

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It is therefore vital to have some assessment of perfusion and tissue health during wound assessment. Risk factors should alert a physician to the possible existence of tissue compromise. Some of the most common risk factors regarding tissue perfusion include diabetes mellitus, hypertension, hyperlipidemia and cigarette smoking.

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The why is easy if we are to save limbs and lives we must consider tissue health during every assessment to ensure early detection of tissue compromise.

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One of our clinical challenges in dealing with kids, especially after heart surgery is that they develop low cardiac output syndrome. It's the leading cause of mortality post-surgery. Unfortunately, a lot of the technologies for cardiac output monitoring are made for adults. They are not small enough to fit on neonates. Low cardiac output syndrome is hard to detect. Most of the ways that we do that right now are late features, creating decreased cardiac output, decreased oxygen delivery to the tissue, and then you get organ damage. So how do we find such physiologic changes before they cause end organ damage?

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One of the problems you have with the babies, you don't have large surface areas. A recent technology development from MIMOSA Pro may provide an early detector of low cardiac output syndrome and is uniquely positioned to do that because it never has to touch the baby. We are presently involved in a large validation study to develop this approach for general clinical use.

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One of the most fundamental but powerful clinical tools when managing patients with wounds is visual observation. But this only provides information based on what the eye can see. Spectral imaging however can provide insight into the tissue, showing what the eye cannot see. Therefore, it is increasingly being used within different clinically diagnostic areas including the management of patients with wounds and wound-related parameters.

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Diabetic foot ulceration is a major complication of diabetes, and diabetic patients have up to a 25% lifetime risk of developing a foot ulcer. If untreated, diabetic foot ulcers may become infected and require total or partial amputation of the affected limb. Changes in the large vessels and microcirculation of the diabetic foot are important in the development of diabetic foot ulceration and subsequent failure to heal existing ulcers.

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Multispectral imaging capabilities at the point of care will revolutionise the management of these patients by assessing tissue viability and health, within my community setting.