Using multimodal imaging techniques to monitor limb ischemia: A rapid noninvasive method for assessing extremity wounds

Rajiv Luthra, Joseph D. Caruso, Jason S. Radowsky, Maricela Rodriguez, Jonathan Forsberg, Eric A. Elster, Nicole J. Crane

Research output: Chapter in Book/Report/Conference proceedingConference contributionpeer-review

2 Scopus citations


Over 70% of military casualties resulting from the current conflicts sustain major extremity injuries. Of these the majority are caused by blasts from improvised explosive devices. The resulting injuries include traumatic amputations, open fractures, crush injuries, and acute vascular disruption. Critical tissue ischemia - the point at which ischemic tissues lose the capacity to recover - is therefore a major concern, as lack of blood flow to tissues rapidly leads to tissue deoxygenation and necrosis. If left undetected or unaddressed, a potentially salvageable limb may require more extensive debridement or, more commonly, amputation. Predicting wound outcome during the initial management of blast wounds remains a significant challenge, as wounds continue to "evolve" during the debridement process and our ability to assess wound viability remains subjectively based. Better means of identifying critical ischemia are needed. We developed a swine limb ischemia model in which two imaging modalities were combined to produce an objective and quantitative assessment of wound perfusion and tissue viability. By using 3 Charge-Coupled Device (3CCD) and Infrared (IR) cameras, both surface tissue oxygenation as well as overall limb perfusion could be depicted. We observed a change in mean 3CCD and IR values at peak ischemia and during reperfusion correlate well with clinically observed indicators for limb function and vitality. After correcting for baseline mean R-B values, the 3CCD values correlate with surface tissue oxygenation and the IR values with changes in perfusion. This study aims to not only increase fundamental understanding of the processes involved with limb ischemia and reperfusion, but also to develop tools to monitor overall limb perfusion and tissue oxygenation in a clinical setting. A rapid and objective diagnostic for extent of ischemic damage and overall limb viability could provide surgeons with a more accurate indication of tissue viability. This may help reducing the number of surgical interventions required, by aiding surgeons in identifying and demarcating areas of critical tissue ischemia, so that a more adequate debridement may be performed. This would have obvious benefits of reducing patient distress and decreasing both the overall recovery time and cost of rehabilitation.

Original languageEnglish
Title of host publicationMultimodal Biomedical Imaging VIII
StatePublished - 2013
Externally publishedYes
EventMultimodal Biomedical Imaging VIII - San Francisco, CA, United States
Duration: 2 Feb 20132 Feb 2013

Publication series

NameProgress in Biomedical Optics and Imaging - Proceedings of SPIE
ISSN (Print)1605-7422


ConferenceMultimodal Biomedical Imaging VIII
Country/TerritoryUnited States
CitySan Francisco, CA


  • 3CCD contrast enhancement
  • infrared imaging
  • limb ischemia
  • perfusion
  • tissue oxygenation


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