(CS-142) Advanced Assessment of the Colorectal Incision with Long Wave Infrared Thermography (LWIT)

Co-Author(s):

Introduction: The risk of infection after colorectal surgery is threefold compared to other sites.¹ Surgical-site infection (SSI) after enterostomal closure has been reported at 2%-41%.² Delayed detection of SSI results in prolonged recovery and higher costs.³

Indicators of delayed incisional healing may not be visible in the initial stages; the temperature can be subjective and challenging to assess.   This work aims to use Long Wave Infrared Thermography (LWIT) to assess the colorectal incision via infrared feedback and provide pathophysiologic findings. Previous research shows delayed healing can be detected using LWIT within the first four days after surgery for Colorectal patients.³

Methods: LWIT* images of the incision were taken at the bedside as part of the nursing assessment to assess healing delays.  The LWIT* software measured the incision and surrounding skin temperature differential.  Adequate blood supply within the wound bed is required to deliver oxygen and to sustain normal healing.  Cold spots along the surgical wound indicate poor blood supply, leading to delayed healing.⁴

Results: These three cases show a thermally cool area along the distal incision prior to visible infection or dehiscence.  Case one showed a progressing cool spot with serial imaging.  Case two showed incisional coolness and dehisced with positive MRSA cultures the following day. Case three visually showed minimal inflammation and thermally showed a vast inflammation spreading beyond the incision line and a cooler area at the distal incision. 

Discussion: Along with the clinical history, LWIT imaging can be an adjunct to support the assessment of incisional site healing delays, which could be identified (by lower temperatures) prior to dehiscence.

Trademarked Items: LWIT, Long Wave Infrared Thermography

References: 1. Ortega, G., Rhee, D.S., Papandria, D. J, Yang, J., Ibrahim, A.M., Shore, A. D., Makary, M.A., & Abdullah, F. (2011). An evaluation of surgical site infections by wound classification system using the ACS-NSQIP. The Journal of Surgical Research, 174(1),33-38.
2. Tan, W. S., Lim, J. F., Tang, C. L., & Eu, K. W. (2012). Reversal of Hartmann's procedure: Experience in an Asian population. Singapore Medical Journal, 53(1), 46–51.
3. Siah C‐J.R., Childs C., Chia C.K., & Cheng K.F. (2019). An observational study of temperature and thermal images of surgical wounds for detecting delayed wound healing within four days after surgery. Journal of Clinical Nursing. 28(11-12),2285–2295.
4. Demidova‐Rice, T.N., Hamblin, M.R., & Herman, I.M (2012). Acute and impaired wound healing. Advances in Skin & Wound Care, 25(7), 304-314.