India has over 74 million people currently diagnosed with diabetes today with ~35% at risk for diabetic foot ulcers (DFUs). Most patients with DFUs do not require hospitalization unless they have a severe infection with possible sepsis or require surgical intervention. Therefore, DFU care can remain remote for low-risk cases. However, high-risk DFU cases need to be identified and triaged to prevent worsening and hospitalization. These patients are catered to by nurses often performing home visits for wound dressing but with the least wound expertise. Hence, there is a need for point-of-care technologies to triage high-risk DFUs requiring clinical visitation vs stable low-risk DFUs. Recently, a smartphone device or SmartPhone Oxygenation Tool (SPOT) was developed as an add-on optical module to estimate 2D oxygen saturation maps. The hypothesis is that DFUs which are highly infectious or necrotic have poor oxygenation distribution around the wound and can be assessed using our SPOT device as high-risk ulcerations that would require clinical follow-up or visitation. A pilot study was conducted on 11 subjects (43-72 years and 9 male) at Dr. Mohan’s Diabetes Specialties Center (India) to observe oxygen distributions in DFUs and determine if SPOT can be established to triage high-risk DFU cases. Oxygenation patterns in complicated (or high-risk) DFUs, as determined by the clinician, were notably different from those that were stable or low-risk DFUs.
Approximately 34% of people with diabetes will experience a diabetic foot ulcer (DFU) at some point throughout their lifetime. The perfusion of oxygen to the DFU is critical for promoting wound healing and closure. However, complications from diabetes can compromise the oxygenated flow to the wound site. Techniques such as transcutaneous oximetry and laser Doppler imaging have been used to assess perfusion to DFUs at discrete point-locations in the peri-wound. Widearea measurements of temporal oxygenation changes, as an indirect measure of perfusion, can provide additional insight of the oxygenated flow in the (peri-)wound and background tissue. Herein, our objective is to assess the differences in oxygenation flow patterns in and around the DFU regions and in the feet of control subjects as a potential biomarker for monitoring wound healing. Breath-holding (BH), as a stimulus, holds the potential to induce oxygenated flow pattern changes in the presence of wounds. In this study, 10 DFU and 3 control subjects were imaged using a hand-held nearinfrared optical scanner (NIROS). Spatial-temporal oxygenation maps of hemoglobin-based parameters were acquired across an 120-second paradigm with 20 seconds of breath-hold. The oxygenation flow patterns obtained from Pearson'sbased correlation maps across controls, healing DFU, and non-healing DFU indicated that flow patterns varied distinctly. Ongoing work is to correlate oxygenated flow patterns to clinical assessment of healing status in DFUs.
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