Background: The visual assessment of burned skin is inherently subjective, and whilst a number of imaging modalities have identified quantifiable parameters to characterize vascular and structural changes following burn damage, none have become common place in the assessment protocol. Here, we use optical coherence tomography (OCT)-based angiography (OCTA) to introduce novel correlations between vessel depth, i.e., the depth of functional blood vessels beneath the tissue surface, edema depth, i.e., the depth of interstitial fluid buildup beneath the tissue surface, and tissue injury depth, i.e., the depth of collagen denaturation beneath the tissue surface, following burn injury.
Methods: A clinical prototype OCT system was used to collect OCT images from various sites of burned skin in patients. Optical microangiography (OMAG) algorithm was used to derive OCTA information from the acquired OCT images, from which the presence of blood vessels and edema were detected. The optical attenuation mapping of structural OCT information was used to detect tissue injury depth. The depths of vessel, edema and tissue injury were measured using a semi-automatic segmentation algorithm. Correlation analysis was performed using a Pearson correlation coefficient using one-tailed analysis with significance being established by a P value ≤0.05.
Results: Four burn patients were recruited and scanned at multiple sites using the prototype system within 3-6 days of injury. Approximate measurements include a vessel depth range of 320-1,360 µm, an edema depth range of 0-400 µm, and a tissue injury depth range of 130-420 µm. Correlations were subsequently observed between vessel depth and edema depth (r=0.8521, P=0.0001), and vessel depth and tissue injury depth (r=0.6296, P=0.0106).
Conclusions: OCT is feasible to provide the critical information of vessel depth, edema depth, and tissue injury depth of skin burns, which may represent viable assessment criteria for the characterization of cutaneous burns in future.
Keywords: Optical coherence tomography angiography (OCTA); attenuation mapping; burn assessment; edema depth; skin; tissue injury depth; vessel depth.