Life of a Wound: Serial Documentation of Wound Healing After Shave Removal Using Reflectance Confocal Microscopy
May 2019 | Volume 18 | Issue 5 | Case Reports | 472 | Copyright © May 2019
Radhika Srivastava BA, a Catherine Reilly BS,a Gina Francisco MBS,a Hamza Bhatti DO,a Babar K. Rao MDa,b
aRutgers Robert Wood Johnson Medical School, Somerset, NJ bWeill Cornell Medical Center, New York, NY
ing shows that the inflammatory phase occurs within 1-7 days after insult, the proliferative or new tissue formation phase occurs within 1-4 weeks, and the remodeling phase occurs from 4 weeks to months or years, which is consistent with the physiology of wound healing.7 RCM has several benefits as compared to biopsy and histopathology in the study of wound healing. RCM allows the same location of the skin to be imaged over time. Additionally, the patient is able to avoid the discomfort of multiple biopsies, and clinicians are able to study the skin morphology without any iatrogenic disruption secondary to biopsy.A technical limitation of our methodology is poor contact of the scope secondary to the depressed nature of the wound bed. A new reflectance confocal microscope model has a handheld microscope head (Vivascope 3000, Caliber ID, Rochester, NY) that is significant smaller than the model used in this paper and captures 750 μm X 750 μm horizontal images. Manual pressure exerted on this handheld microscope allows improved contact with the varying topography of skin, but it can be difficult to correlate individual images produced with the location of the lesion. Complex algorithms utilizing the handheld microscope are being developed to stich individual images together and correlate the image taken with the clinical location, but such programs are not yet widely available.8 The traditional RCM model was selected to image this wound due to its ability to visualize the entire lesion and surrounding tissue in one 8 mm X 8 mm mosaic image, maintaining the geography of findings relative to the lesion, rather than multiple smaller images that would have been produced by the handheld microscope. Future studies are needed to optimize RCM methodology to monitor wound healing.
This case documents serial in vivo RCM imaging of a wound following shave excision, and our findings are consistent with what is known about the stages of wound healing.
Babar Rao is a consultant for Caliber ID (Rochester, NY).
- Rajadhyaksha M, Marghoob A, Rossi A, Halpern AC, Nehal KS. Reflectance Confocal Microscopy of Skin In Vivo: From Bench to Bedside. Lasers Surg Med. 2017; 49(1):7–19.
- Rao BK, John AM, Francisco G, Haroon A. Diagnostic Accuracy of Reflectance Confocal Microscopy Skin. Arch Pathol Lab Med. 2018 Oct 8.
- Cameli N, Mariano M, Serio M, Ardigò M. Preliminary comparison of fractional laser with fractional laser plus radiofrequency for the treatment of acne scars and photoaging. Dermatol Surg. 2014; 40(5):553-61.
- Stumpp OF, Bedi VP, Wyatt D, Lac D, et al. In vivo confocal imaging of epidermal cell migration and dermal changes post nonablative fractional resurfacing: study of the wound healing process with corroborated histopathologic evidence. J Biomed Opt. 2009;14(2):024018.
- Terhorst D, Maltusch A, Stockfleth E, Lange-Asschenfeldt S, et al. Reflectance confocal microscopy for the evaluation of acute epidermal wound healing. Wound Repair Regen. 2011;19(6):671-9.
- Lange-Asschenfeldt S, Bob A, Terhorst D, Ulrich M, et al. Applicability of confocal laser scanning microscopy for evaluation and monitoring of cutaneous wound healing. J Biomed Opt. 2012;17(7):076016.
- Gurtner GC, Werner S, Barrandon Y, Longaker MT. Wound repair and regeneration. Nature. 2008;453(7193):314-21.
- Kose K, et al. Automated video-mosaicking approach for confocal microscopic imaging in vivo: an approach to address challenges in imaging living tissue and extend field of view. Sci Rep. 2017;7(1):10759. doi: 10.1038/s41598-017- 11072-9