The use of laser Doppler imaging as an aid in clinical management decisionmaking in the treatment of vesicant burns

Vesicants are a group of chemicals recognised, under the terms of the Chemi cal Weapons Convention, as potential chemical warfare agents whose prime ef fect on the skin is to cause burns and blistering. Experience of the clinic al management of these injuries is not readily available and therefore an a ccurate assessment of the severity of the lesion and extent of tissue invol vement is an important factor when determining the subsequent clinical mana gement strategy for such lesions. This study was performed to assess the us e of laser Doppler imaging (LDI) as a noninvasive means of assessing wound microvascular perfusion following challenge with the vesicant agents (sulph ur mustard or lewisite) by comparing the images obtained with histopatholog ical analysis of the lesion. Large white pigs were challenged with sulphur mustard (1.91 mg cm(-2)) or lewisite (0.3 mg . cm(-2)) vapour for periods o f up to 6 h At intervals of between I h and 7 days following vesicant chall enge, LDI images were acquired and samples for routine histopathology were taken. The results from this study suggest that LDI was: (i) a simple, repr oducible and noninvasive means of assessing changes in tissue perfusion, an d hence tissue viability, in developing and healing vesicant burns; (ii) th e LDI images correlates well with histopathological assessment of the resul ting lesions and the technique was sufficiently sensitive enough to discrim inate between skin lesions of different aetiology. These attributes suggest that LDI would be a useful investigative tool that could aid clinical mana gement decision making in the early treatment of vesicant agent-induced ski n burns. (C) 1998 Elsevier Science Ltd for ISBI. All rights reserved.