Romanelli M, Dini V, Bianchi T, Romanelli P. Wound Assessment by 3-Dimensional Laser Scanning. Arch Dermatol. 2007;143(10):1331–1344. doi:10.1001/archderm.143.10.1333
Recent advances in our understanding of the biology of cutaneous tissue repair have influenced current therapeutic strategies for chronic wound management and will continue to influence chronic wound management strategies into the future.1
An effective and accurate monitoring of skin lesions should be performed by measuring in an objective, precise, and reproducible way the complete status and evolution of the wound.2 The main goal of current research projects is to design an easy-to-use technological system that can monitor the qualitative and quantitative evolution of a skin lesion.
This level of monitoring can be achieved by using 3-dimensional scanners: in particular, systems based on active optical approaches.3 There are 2 different areas of potential applications of such types of devices: in medical treatment (to improve the efficacy of therapeutic regimens)4 and pharmacologic scientific research (to assess the quality and effectiveness of new chemicals or clinical procedures).5
We prospectively examined 15 patients with venous leg ulcers. The patients who underwent sequential imaging of chronic wounds for this study all attended the leg ulcer clinic of the Wound Healing Research Unit at the University of Pisa, Pisa, Italy.
Our sequential imaging system is equipped with a Vivid 900 laser scanner (Minolta, Osaka, Japan), which is used for digitizing or scanning the wound shape. With regard to the calculation of the “external” surface and volume of a wound, it is necessary to assess its original shape to determine the missing volume virtually. At the time of patient presentation, information on the shape of the skin before the wound occurred is missing, and the technique for virtual reconstruction of the original wound surface must be as easy and user-friendly as possible. The system, relying on an analysis of the shape of the surface immediately outside the wound perimeter, creates an interpolating virtual surface that is continuously connected to the existing surface outside the wound and to that covering it.
The parameters we studied were the mean wound area (measured in square centimeters) and mean volume (cubic centimeters). To assess interrater reproducibility, scans were evaluated by 2 independent investigators. For assessment of intrarater reproducibility, a single investigator performed 2 consecutive measurements 5 minutes apart. Immediately after the first wound assessment of the first observer, a second observer, blinded to the findings of the first analysis, measured the same wound.
The means and standard deviations of duplicate determinations for each wound were used for analysis. The reproducibility of measurements was evaluated by means of an intraclass correlation coefficient (ICC) and its 95% confidence interval (CI).
The measured total areas and volumes for independent raters and for subsequent measures of 1 rater are reported in Table 1. No statistically significant differences were found between scans evaluated by the 2 investigators about wound area and volume. The relative errors and the intraclass correlation coefficients are reported in Table 2. The ICC values were excellent for both intrarater and interrater reproducibility with a very low relative error value. The mean ± SD time for a full scan acquisition on the wound area and volume was 3.6 ± 1.4 minutes.
The laser scanner system used in this study enables users to accurately acquire 3-dimensional digital models of various types of skin wounds. Since the final users will be physicians and not computer experts, a user-friendly system is believed to be a fundamental parameter for its success.
The accuracy of scanning systems has improved in the past few years, and prices have also decreased, making these devices affordable for a wider community of potential users.6 The integration into a single system of capabilities that can capture the shape and surface reflection characteristics makes 3-dimensional scanning an invaluable resource in all those applications where it is necessary to sample both surface attributes.
Correspondence: Dr Romanelli, Wound Healing Research Unit, Department of Dermatology, University of Pisa, Via Roma, 67, 56126 Pisa, Italy (firstname.lastname@example.org).
Financial Disclosure: None reported.