I think imaging is extremely
important. And, you know, we talked about mentoring young people. Imaging is
not what you get when you don't know what's going on. I think imaging is there
to complement your physical examination and your thought process and to give
you the confidence that you're in the right area. If you look at burns, there
are very few experiences with imaging. There had been a laser doppler that was
looking at the second degree burns, showing you different colors, giving you a
sense of how deep that burn was, but the cost of that was just prohibitive. ,
and the question is when you use it, so if I'm gonna add something to burns in
the form of imaging. I'm gonna try to find out how much dermis is left on that
wound when I can't really see it in the beginning, follow it along to
understand that zone of injury, whether I'm losing the dermis, , and whether
it's an extremely deep burn because I wanna know whether I should treat that
patient a little more conservatively, with the expectation of healing.
, and that would be extremely
important. Third degree burn. , there's not much you can tell a very deep third
degree burn. If you look at the etiology, a flame burn, electrical burn, , that
tissue needs to be debrided. There's no question. But your second degree burns
your children where you're going to give them a little benefit of the doubt
because they have a different quality skin. If I had an imaging availability like ultrasound, which I think is easy to do. I
mean, you need the technical aspect, but if that can tell me as I saw in one of
his papers that I have a subdermal circulation still intact and that I have a
layer of dermis that's healthy, that would tell me I can go into skin
substitutes because this wound is going to heal. But you're going to need to
follow that up because a burn will change on a daily basis.
, you may get a sense that the
zone of injury is greater than you thought and you may be losing dermis in the
first two or three days. And that would lead us into stage two, which is not so
much can I get that burn to heal, but what is the quality of that healing
process? So if I have a very deep second degree burn and it takes two months
for that burn to heal, I'm not sure I've done, , a justice for that patient
because I know that the hypertrophic, restrictive scarring secondarily and even
the aesthetics of that burn secondarily, , may not be what I want. And it may
render the patient, , at a loss of function requiring more and more surgical
procedures to catch up when maybe I could have avoided that by entering early.
So imaging to show me the depth of the burn with consistency, follow that so I
can say, yes, I'll continue that skin substitute because this burn will heal
within two to three weeks, and I know that long term my scarring will be
acceptable.
And then the other thing I spoke with Dr. Bard about is looking at these burned scars after they've healed. And if you can image that and obtain a sense of quality of that scar, that would tell me whether therapy pressure treatment secondarily, will mature the scar enough so my function will return. If you look at the hand, a burn over the dorsal of the hand is going to be restrictive. If you can look at a patient who's been treated conservatively, but yet now there's hypertrophic scarring, can you tell me that that will mature with the right therapy and stretch? And if you can classify that or quantify that, then I would know whether I should intervene early because telling the patient, yes, you'll need three months of therapy, and by the way, you probably won't be much better than you were before. That's not what I want to see.
So this would give me early
insight into the quality of healing. So it's, will it heal and if it heals,
what is the quality? And I think those are the two major concerns that I have.
And I will tell you with skin substitutes, , I hear a lot, , I often at the
meetings would listen to the people at the tables and they would tell me what
they wanted to tell me, but I would often get access to the scientists behind
that and we would talk about those principles. So my question was, okay, you
can get this burn to heal, but if you're showing me something that heals in two
or three months, you know, talk to me about the quality of that healing
process. And that was usually something that I didn't hear very much about. So
that would be a great interest to me.
Awesome. , I'm gonna have a
part two to this question from my own self, , because we are constantly writing
about this term landmines, landmines, meaning surprises under the skin. Now
this isn't just on in terms of your field, but essentially there is a simpatico
between your expertise and dermatology in a sense that there's a lot of
different science, there's a lot of different areas to look at with skin if you
are working from skin down to be able to say that even we have, , a hair
implant, people with scalp for example, where before you start doing the
implants, do a quick scan of the scalp because there are landmines in there
that are possible. Well, we, we also call it lawsuit prevention, but we're not
publishing it in that term. Right? , , squamous cell melanoma carcinoma, these
things, believe it or not, show up underneath the skin and if you don't know
it, you could be popping something that that needs to be biopsied. Do you have
any thoughts in terms of using imaging to protect the clinician from surprises
or at least to be able to do a due diligence for the sake of safety for both
the clinician as well as the patient landmines?
Well, if, , if you're talking
about hair transplantation, , not something that I've really done very much of
in some burn cases, I've taken segments of skin with hair bearing tissue and
transferred those in. But I think imaging in that area would identify the
quality of the tissue in which you're putting that transplant into, has to be
well vascularized, the quality of softness. And if you can qualify that with
the imaging, I think you're ahead of that. , I think if you can show a
prophylactic process whereby you can look at these skin lesions and determine
are they squamous cell, , are they just keratosis in here? I mean, that would
be a tremendous asset for a dermatologist who has to biopsy a lot of these to
really get the answer they're looking for. So again, imaging would play a role,
, early on, allow you to follow it. , , imaging ultrasound, I imagine can be
reproducible very, very, very quickly, , and I imagine somewhat inexpensively.
And I think those are the keys to knowing what you're dealing with there. So
yeah, I think it plays a great role.
RESEARCH:
I think that would be something of interest to me. I mean, you know, I, I've been passionate about this for a very, very long time. A lot of it was in the surgical field, so you're operating all the time, but the thought process behind making the diagnosis, operating, getting the outcome you want, always something of been of interest to me. So yes, research I think is something I would be interested in.
