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Tissue perfusion assessment of paediatric burns by laser doppler Imaging (LDI).

Introduction: The indication for performing autologous skin grafts in cases of burns in children is based on the clinical examination by trained surgeons and on the progression of spontaneous healing during the first seven to ten days. Spontaneous regeneration of the skin after a burn depends on the presence of tissue microcirculation. Laser Doppler Imaging (LDI) is a non-invasive method for assessing tissue perfusion. The objective of this pilot study was first, to measure tissue perfusion by LDI over the course of the first few days after a burn and second, to show the usefulness of LDI when having to decide whether or not to perform a skin graft. Materials and methods: A prospective pilot study involving children with second-degree burns covering a minimum of 10% of the Total Body Surface Area (TBSA) was conducted over 14 months from May 2012 to July 2013. The treatment of the lesions followed the typical pattern of showers every other day and the use of hydrofibre dressings. LDI images of the burned skin were made under standardized conditions during hydrotherapy over the first ten days and also, at the same time, of healthy skin in order to obtain a reference value. A clinical assessment determining the degree of severity of the burns of each patient was carried out by the paediatric surgeon. The analysis of the results was performed with the EasyLDI Studio program. Results: This pilot study included seven patients. Our results show a correlation between the numerical perfusion values obtained by LDI and the depth of the burn as determined by the surgeon. The perfusion threshold requiring treatment by skin grafting is set at 74% of the perfusion of healthy skin. In 70% of the cases, the sensitivity of the Laser Doppler imager helps determine during the first few days after the burn whether a skin graft will be necessary. Discussion and conclusion: Laser Doppler Imaging (LDI) helps to numerically objectify the residual perfusion of burned tissue. In 70% of the cases, it makes it possible to estimate at an early stage whether a skin graft will be necessary.

Author(s): Mermod T, Kolly S, Raffoul W, El Ezzi O, Anthony S de Buys Rousing