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Table of Contents
LETTER TO EDITOR
Year : 2020  |  Volume : 17  |  Issue : 2  |  Page : 126-127

Thermographic appearance of dead necrotic tissue around a vicryl thread and sero-purulent discharge from the wound


1 Department of Neurosurgery, Narayana Medical College Hospital, Nellore, Andhra Pradesh, India
2 Department of Pharmacology, Narayana Medical College Hospital, Nellore, Andhra Pradesh, India

Date of Submission12-Apr-2019
Date of Acceptance16-Apr-2020
Date of Web Publication18-Jun-2020

Correspondence Address:
Amit Agrawal
Department of Neurosurgery, Narayana Medical College Hospital, Chinthareddypalem, Nellore - 524 003, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/am.am_18_19

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How to cite this article:
Srigiriraju V, Ramamohan P, Katikala M, Reddy VV, Agrawal A. Thermographic appearance of dead necrotic tissue around a vicryl thread and sero-purulent discharge from the wound. Apollo Med 2020;17:126-7

How to cite this URL:
Srigiriraju V, Ramamohan P, Katikala M, Reddy VV, Agrawal A. Thermographic appearance of dead necrotic tissue around a vicryl thread and sero-purulent discharge from the wound. Apollo Med [serial online] 2020 [cited 2020 Jul 8];17:126-7. Available from: http://www.apollomedicine.org/text.asp?2020/17/2/126/287080



Sir,

Infrared (IR) thermography has been used to manage many clinical conditions, including breast cancer, diabetes, to monitor wound healing, dentistry, to diagnose arthritis and diabetic neuropathy, and many other clinical conditions.[1],[2],[3],[4],[5] A 27-year-old man underwent spinal fixation of traumatic L1 wedge fracture 1 month back. He did not have any neurological deficits, and he had an uneventful postoperative recovery. Now he presented with serous discharge from the operative site. There was no history of fever. Local examination revealed apparently healthy except a small hole with serous discharge and extruded vicryl thread. There was no local pain, redness, or the local rise of temperature [Figure 1]a. The patient was submitted for thermographic examination, and it showed area suggestive of avascularity around the discharge site [Figure 1]b and c]. There were areas of hypervascularity around the surgical scar, and two areas were extending where the self-retaining retractors were placed during surging to achieve retraction to expose the spine. The vicryl thread was removed, and the patient is doing well at follow-up.
Figure 1: (a) Clinical photograph showing postoperative scar with visible vicryl thread and wound discharge, (b and c) thermal visual images showing areas of decreased vascularity as cold spots, the area with retained vicrl thread and sero-purulent discharge appears larger in size

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The human skin is considered as a perfect black body (the emissivity is 0.98) and emits the heat energy, which can be detected with IR camera to create a visual map of surface temperature distribution (thermogram).[6],[7],[8] IR thermography is a simple, noninvasive, and safe method to assess physiological and morphological changes on the surface of the skin.[1],[8],[9],[10] The role of IR thermography has been explored to assess get the visual feedback regarding wound healing.[9] In the presented case, presence of vicryl thread created an area on inflammation leading to dead necrotic tissue, which appeared as cold spot on IR thermography images. The removal of vicryl thread resulted in enhanced wound healing and relief in sero-purulent discharge. In summary, the technique of IR thermography is nonspecific yet has the potential to identify areas of inflammation or decreased circulation as hot or cold spots, respectively, and a careful clinical correlation can further help in making a management decision.[1],[9],[11]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Lahiri BB, Bagavathiappan S, Jayakumar T, Philip J. Medical applications of infrared thermography: A review. Infrared Phys Technol 2012;55:221-35.  Back to cited text no. 1
    
2.
Collins A, Ring E, Cosh J, Bacon P. Quantitation of thermography in arthritis using multi-isothermal analysis. I. The thermographic index. Ann Rheum Dis 1974;33:113.  Back to cited text no. 2
    
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Ring EF, Collins AJ, Bacon PA, Cosh JA. Quantitation of thermography in arthritis using multi-isothermal analysis. II. Effect of nonsteroidal anti-inflammatory therapy on the thermographic index. Ann Rheum Dis 1974;33:353-6.  Back to cited text no. 5
    
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Bronzino JD, editor. Medical Devices and Systems. 1st ed. Boca Raton: CRC Press; 2006.  Back to cited text no. 6
    
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Diakides M, Bronzino JD, Peterson DR, editors. Medical Infrared Imaging: Principles and Practices. 1st ed. Boca Raton, FL: CRC Press; 2012.  Back to cited text no. 7
    
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Jones BF. A reappraisal of the use of infrared thermal image analysis in medicine. IEEE Trans Med Imaging 1998;17:1019-27.  Back to cited text no. 8
    
9.
Bharara M, Schoess J, Nouvong A, Armstrong DG. Wound inflammatory index: A “proof of concept” study to assess wound healing trajectory. J Diabetes Sci Technol. 2010;4:773-9.  Back to cited text no. 9
    
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Uematsu S. Symmetry of skin temperature comparing one side of the body to the other. Thermology 1985;1:4-7.  Back to cited text no. 10
    
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Roback K, Johansson M, Starkhammar A. Feasibility of a thermographic method for early detection of foot disorders in diabetes. Diabetes Technol Ther 2009;11:663-7.  Back to cited text no. 11
    


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