Narrowing the focus on wounds

A project is aiming to develop a fast, computer-aided and non-invasive test to improve the treatment and healing outcomes of venous leg wounds. Natasha Egan reports.

A research collaboration involving aged care provider Bolton Clarke is using a new technique known as narrow band imaging in a bid to improve outcomes for people with venous leg ulcers (VLUs).

VLUs are caused by poor vein function and they are a major source of pain and disability in Australia, affecting about 1 per cent of Australians including aged care recipients. They often have poor healing rates.

RMIT University is leading the project, which is funded by Trajan Scientific and Medical. It builds on previous RMIT research led by Professor Dinesh Kumar that used narrow band imaging to predict the healing of foot wounds in people with diabetes.

Kylie Elder, a senior clinical nurse advisor with Bolton Clarke, says this project is evaluating whether the same technique can be used to predict venous leg ulcers unlikely to heal as quickly as they should.

“We have lots of evidence about how to treat VLUs and we do have some indicators based on the person’s medical history and their assessment to see what type of healing we are going to get.

“This project is a way to look at it to see if we can predict whether they would go on to heal or not,” Elder tells Australian Ageing Agenda.

If it works, for clients it means they can have access to the best treatment available and a wound specialist straightaway if a wound is identified as difficult to heal, she says.

VLUs are the most commons wounds seen in the community, says Elder. While skin tears and pressure injuries are the most prominent types of wounds in residential aged care, VLUs are also an issue. Any findings from this project will be relevant to wounds in all settings, she says.

Trialling a fast, non-invasive test

Elder is working with Dr Rajna Ogrin, a senior research fellow with Bolton Clarke Research Institute, on the project. Ogrin says the project aims to close a gap by developing a fast, computer aided, non-invasive test that will help healthcare providers decide the best form of treatment for a person with a VLU and help more people with these wounds to heal.

“Currently, we don’t have a quick and simple way to know which of these wounds will heal normally, and which ones may have delayed healing, or not heal at all,” Ogrin says.

For the project, researchers captured normal and narrow band imaging photographs for 85 wounds in 67 Bolton Clarke clients in the community for data analysis.

“Narrow band images are just like normal photos except that instead of just three colour channels – red green and blue, known as RGB – the device takes a photo with up to 100 colour channels,” Ogrin says. “This reveals more information about the chemistry of the wound, which currently can only be found out with swabs and biopsies,” she says.

The five sets of images were taken at the first and four follow-up appointments over four weeks, and clients were followed up after 12 and 24 weeks to see which wounds healed.

Informing best practice

Elder says the colour channels show greater characteristics about the wound such as the texture of it, how much blood is getting through and the fluid coming out of the wound. VLUs often cause swelling and fluid and then that fluid leaks out, she says.

“People end up with these wet legs and with skin that breaks down. Sometimes those ulcers can be circumferential, so huge areas around their legs.

“The gold standard to care is to put them into compression and bandaging or garments. That helps the valves in the vein to get venous return back to you heart and also assist in getting rid of that fluid.

“It is not uncommon for people to have a recurrence of these leg ulcers as well so it is important that once we have them healed we maintain them in some sort of compression garment hosiery or something like that,” she says.

“If we can predict whether they are going to be difficult to heal then we can get that specialist input from the outset and make sure everything is ticked off. And we have a plan to prevent it as well.”

The study has gathered all of its data and the photographs and healing information are now being analysed using the RMIT purpose built proprietary analysis software by Professor Kumar.

Elder says they are looking at other outcomes as well as the imaging, for example, also picks up inflammation around the wounds.

“There are a couple of other things that might come out such as whether there are certain disease processes that come out of the inflammation of venous leg ulcers.”

Results of the study are expected to be available by the end of 2020.

Nursing from home

Like many, Elder is working from home due to the COVID-19 pandemic at the time of speaking. Her role as a senior clinical nurse advisor involves policy, procedure and governance and that includes wound consulting.

“I do lots of wound consulting remotely now,” Elder says. “I do specialist remote consultant for all of our aged care facilities in Queensland and in New South Wales on wounds.”

Elder says she and Bolton Clarke were doing consultations remotely before the pandemic, but it’s even more advanced now. And it is proving to be just as effective as in-person consultations, she says. 

“I have access to our client management system and its electronic client records.  I get referrals through from our facilities and then I will go in and have a look at the images,” Elder says.

“We might video consult where they take the iPad down to the residents for me to look. I might phone and be in contact with the staff at the site and be involved in family meetings.”

She says family members have also embraced the remote consultations, which can be more accessible than traditional meetings.

“Just being there on Microsoft teams; it is amazing. You can get just as much done as you can face to face.”

This article first appeared in Australian Ageing Agenda magazine (Sep-Oct 2020).

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