Use of 3D Surface Imaging to Study Wound Dressing Fixation
Use of 3D Surface Imaging to Study Wound Dressing Fixation
The performance of dressings significantly affects wound healing and quality of life for patients. Despite extensive collective nursing care experience, uncertainty remains about the optimum choice of many parameters that affect dressing performance, such as shape, extensibility, and fixing position. A technique was developed to investigate some of the parameters involved in the fixing of dressings for acute and chronic wounds. Representative mobile areas in the upper torso, neck, and leg were chosen for surface modeling. Digital surface photogrammetry was used to obtain surface data for various sites in young, middle-aged, and elderly subjects. In each case, landmarks were used to identify a grid of points in a region of skin, and the relative movements of the points were found following typical movements of the appropriate body part. The amounts and orientation of deformation of the skin were computed and displayed in such a way that some preliminary hypotheses could be made concerning why dressings may fail in practice.
The performance of dressings significantly affects wound healing and quality of life for patients. Despite extensive collective nursing care experience, uncertainty remains about the optimum choice of many parameters that affect dressing performance, such as the shape, extensibility, and fixing position of the dressings. The context of this study was an assessment of the potential for stereo-photogrammetry to provide quantitative information to support clinicians and dressing designers. Specifically, this was a pilot study to investigate the influence of skin deformation on the fixing of dressings used in the treatment of a variety of acute and chronic wounds, such as leg ulcers, pressure ulcers, and post-operative wounds. The reference skin surfaces chosen were the upper torso, neck, and legs. The intention was not to conduct a comprehensive, statistically significant trial but to investigate the utility of a novel technique on a range of subjects with varying skin properties.
Digital surface photogrammetry techniques were developed to obtain shape information for various sites on the neck and legs of young, middle-aged, and elderly subjects. Subjects entered into the study included volunteers with a range of ages from the Department of Medical Physics and selected patients from the Vascular Unit at the Bradford Teaching Hospitals NHS Foundation Trust (Bradford, Yorkshire, UK). First, the subject was marked using adhesive labels or marker pens to identify a grid of points on the skin around the neck, knee, or ankle. Images were captured using a DSP 400 3D-imaging system manufactured by 3dMD Ltd. (Atlanta, Ga, USA). Positional differences of the grid points were computed when the subject was relaxed and when he or she made typical movements to articulate the joint in the region of interest. Studies were conducted with and without dressings affixed. The data from these positional changes can be used to compute parameters that indicate changes in the shape of the study area. Two major parameters were thought to be significant: skin stretch and skin shear. In this article, the use of skin stretch is examined. Software (3D MedPlot, developed by the Department of Medical Physics, Bradford Teaching Hospitals NHS Trust) was developed to enable rapid, semi-automated assessment, analysis, and display of skin deformation under joint movement. The results were displayed by color-coding the grid to highlight the regions of skin that compressed or stretched. Absolute and relative changes were tabulated alongside the display. Individual arcs in the grid can be selected for closer study.
Preliminary studies have highlighted the complex and sometimes counter-intuitive response of skin to joint articulation. In the neck study, it was observed that while skin in the central part of the neck was stretching, there was a region of skin compression over the adjacent shoulder in a direction orthogonal to the direction of stretch. In the ankle study, it was observed that while skin deformed uniformly without a dressing, there was significant wrinkling of the skin with a dressing. These observations suggest some hypotheses as to why the fixation of dressings may fail in practice.
The performance of dressings significantly affects wound healing and quality of life for patients. Despite extensive collective nursing care experience, uncertainty remains about the optimum choice of many parameters that affect dressing performance, such as shape, extensibility, and fixing position. A technique was developed to investigate some of the parameters involved in the fixing of dressings for acute and chronic wounds. Representative mobile areas in the upper torso, neck, and leg were chosen for surface modeling. Digital surface photogrammetry was used to obtain surface data for various sites in young, middle-aged, and elderly subjects. In each case, landmarks were used to identify a grid of points in a region of skin, and the relative movements of the points were found following typical movements of the appropriate body part. The amounts and orientation of deformation of the skin were computed and displayed in such a way that some preliminary hypotheses could be made concerning why dressings may fail in practice.
The performance of dressings significantly affects wound healing and quality of life for patients. Despite extensive collective nursing care experience, uncertainty remains about the optimum choice of many parameters that affect dressing performance, such as the shape, extensibility, and fixing position of the dressings. The context of this study was an assessment of the potential for stereo-photogrammetry to provide quantitative information to support clinicians and dressing designers. Specifically, this was a pilot study to investigate the influence of skin deformation on the fixing of dressings used in the treatment of a variety of acute and chronic wounds, such as leg ulcers, pressure ulcers, and post-operative wounds. The reference skin surfaces chosen were the upper torso, neck, and legs. The intention was not to conduct a comprehensive, statistically significant trial but to investigate the utility of a novel technique on a range of subjects with varying skin properties.
Digital surface photogrammetry techniques were developed to obtain shape information for various sites on the neck and legs of young, middle-aged, and elderly subjects. Subjects entered into the study included volunteers with a range of ages from the Department of Medical Physics and selected patients from the Vascular Unit at the Bradford Teaching Hospitals NHS Foundation Trust (Bradford, Yorkshire, UK). First, the subject was marked using adhesive labels or marker pens to identify a grid of points on the skin around the neck, knee, or ankle. Images were captured using a DSP 400 3D-imaging system manufactured by 3dMD Ltd. (Atlanta, Ga, USA). Positional differences of the grid points were computed when the subject was relaxed and when he or she made typical movements to articulate the joint in the region of interest. Studies were conducted with and without dressings affixed. The data from these positional changes can be used to compute parameters that indicate changes in the shape of the study area. Two major parameters were thought to be significant: skin stretch and skin shear. In this article, the use of skin stretch is examined. Software (3D MedPlot, developed by the Department of Medical Physics, Bradford Teaching Hospitals NHS Trust) was developed to enable rapid, semi-automated assessment, analysis, and display of skin deformation under joint movement. The results were displayed by color-coding the grid to highlight the regions of skin that compressed or stretched. Absolute and relative changes were tabulated alongside the display. Individual arcs in the grid can be selected for closer study.
Preliminary studies have highlighted the complex and sometimes counter-intuitive response of skin to joint articulation. In the neck study, it was observed that while skin in the central part of the neck was stretching, there was a region of skin compression over the adjacent shoulder in a direction orthogonal to the direction of stretch. In the ankle study, it was observed that while skin deformed uniformly without a dressing, there was significant wrinkling of the skin with a dressing. These observations suggest some hypotheses as to why the fixation of dressings may fail in practice.
Source...