By Temple University School of Podiatric Medicine Journal Review Club

Editor's note: This post is part of the Temple University School of Podiatric Medicine (TUSPM) journal review club blog series. In each blog post, a TUSPM student will review a journal article relevant to wound management and related topics and provide their evaluation of the clinical research therein.

Article title: The Utility of Smartphone Applications and Technology in Wound Healing.

Authors: Shamloul N, Ghias MH, Khachemoune A,

Journal: Int J Low Extrem Wounds. 2019 Jun 14. doi 10.1177/1534734619853916 [Epub ahead of print].

Reviewed by: Fahad Hussain, class of 2020, Temple University School of Podiatric Medicine

Introduction

The advancement of technology and the introduction of the World Wide Web have allowed information to be a click of a button away for health care providers as well as patients. This advancement led to the demand and production of portal devices such as smartphones, which transformed many aspects of society today, including health care. Today, smartphone applications may aid health care providers in drug reference, diagnosis, treatment, literature search, and even medical training. In 2009, an estimated 6.5 million patients had chronic wounds and spent more than $25 billion dollars on wound care. In addition, rising costs of wound management have suggested the need for the use of mobile applications in treatment of wound care patients. Wound treatment relies on accurately assessing the wound. Some parameters that are often monitored are the surface area, length, width, and depth of the wound. These measurements are often achieved by visual assessments as well as by using a ruler for measurements, giving up to a 44% error margin.

The most common technique used is called the "clock method." This method encompasses the use of an imaginary clock to measure the greatest width, length, and depth of the wound. Another method often used is wound tracing. This method involves using a marker to outline the wound and monitoring the measurements of the wound over time. Although the importance of wound assessment is shown in many studies, a universal method for wound assessment has yet to be defined.

Methods

Studies have shown that skin areas with hyperthermia greater than 2.2° C can possibly be an ulcer. With this in mind, a mobile application was created to detect ulcers by using a mobile thermal camera on a smartphone. To facilitate this device in capturing infrared thermal images, a mobile device was created. The efficacy of both these applications was tested on 37 patients compared with the accepted reference thermometer, Exergen DermaTemp 1001 (Exergen, Watertown, MA). In addition, the use of digital photographs and cross-sectional areas taken another smartphone app were studied, and the images were compared with digital images of tracings of foot ulcers of 31 patients with diabetic foot ulcers.

Telemedicine is another evolving topic discussed in this article. The ability of wound care physicians to assess and treat wounds based on digital photographs was studied in this article. In the first study, images taken by digital cameras by physicians treating 110 patients with chronic leg ulcers were sent to wound care specialists. The wound care specialists then provided assessment of the wound and therapeutic recommendations. In a separate study, 20 patients with diabetic ulcers who were treated using telemedicine consultations were compared with 120 patients receiving in-person consultations.

Results

The studies found that the differences between the reference thermometer and the mobile application were non-significant. In addition, no significant differences were found between the mobile device in measuring cross-sectional areas of wounds. Thus, the investigators concluded that these smart applications could be used to detect signs of infections and to monitor changes of ulcers in time. Results showed high concordance between direct consultations and electric consultation for granulation tissue formation, slough, and necrosis: 76.4%, 84.6%, and 98.2% respectively. Results for the diabetic ulcer study showed no difference between the telemedicine and control groups in measures such as healing time ratio, percentage of forefoot ulcers healed in 12 weeks, and average forefoot ulcer healing time: 1.40 versus 1.00, 75% versus 81%, and 43.2 ± 29.3 days versus 45.5 ± 43.4 days, respectively.

Conclusion

Treatment of wounds takes a great deal of time and uses extensive financial resources in our health care system. Studies mentioned in this literature review show great promise in the use of smartphones for wound care in a controlled setting. Thus, further investigation is needed to evaluate the use of smartphone and applications fully in wound care.

About the Author

Fahad Hussain is a third year podiatric medical student at Temple University School of Podiatric Medicine (TUSPM) in Philadelphia, Pennsylvania. He graduated from University of Houston in 2015 with a Bachelor of Science in biology and minors in chemistry and health. Following graduation, Fahad worked as a medical scribe in an emergency room in Houston. In the fall of 2017, Fahad matriculated at TUSPM with a merit scholarship. He is currently the President of Journal Club, Vice President of the Student National Podiatric Medical Association (SNPMA), Treasurer of the American College of Foot and Ankle Orthopedic Medicine (ACFAOM), and Secretary of the Muslim Student Association (MSA) at TUSPM. Dr. James McGuire is the director of the Leonard S. Abrams Center for Advanced Wound Healing and an associate professor of the Department of Podiatric Medicine and Orthopedics at the Temple University School of Podiatric Medicine in Philadelphia.