Laser Speckle Contrast Imaging for Assessment of Cutaneous Perfusion and Treatment Response During Hyperbaric Oxygen Therapy in Chronic Wounds: A Case Series.

Abstract

Hyperbaric oxygen therapy (HBOT) is an adjunctive treatment for selected chronic wounds with microcirculatory impairment, but treatment response is typically assessed clinically after several weeks. This case series evaluated the feasibility and potential utility of laser speckle contrast imaging (LSCI) for monitoring cutaneous perfusion during HBOT. Six patients with chronic wounds refractory to conventional management underwent HBOT. Cutaneous perfusion was assessed using LSCI before and after HBOT sessions at three predefined regions of interest: referent healthy skin, wound margin and wound bed. Perfusion was quantified in laser speckle perfusion units (LSPUs). Baseline perfusion differed significantly among anatomical regions (Friedman test, p < 0.001). Median perfusion was highest at the wound margin (109 [70-172] LSPU), compared with the wound bed (58 [32-92] LSPU; p = 0.001) and referent healthy skin (45 [36-61] LSPU; p < 0.001). Across monitored HBOT sessions, perfusion increased significantly after treatment in referent skin (+11 [-2 to +18] LSPU; p = 0.022), at the wound margin (+30 [-2 to +64] LSPU; p = 0.005) and in the wound bed (+10 [+1 to +32] LSPU; p = 0.010). Pre-HBOT wound-bed perfusion tended to decrease over the treatment course in most patients, although substantial inter-individual variability was observed. This case series demonstrates the feasibility of repeated, non-invasive LSCI assessment to characterize spatial and acute changes in cutaneous microcirculatory perfusion during HBOT. LSCI appears feasible for monitoring cutaneous perfusion during HBOT. Prospective studies with standardized assessment time points are needed to determine whether LSCI-derived perfusion trajectories or thresholds are associated with wound-healing outcomes and can inform HBOT decision-making.