Application Of Laser Speckle Contrast Imaging(LSCI)in The Diagnosis And Treatment System Of Keloids

BACKGROUND:Keloids and hypertrophic scars(HTS)are characterized by increased collagen deposition during wound healing.Vascularization may play a role in the pathogenesis of keloids.Some studies have shown perfusion in keloids and adjacent skin were significantly higher than that in nonadjacent skin.OBJECTIVE:The aims of this study were to investigate cutaneous perfusion within keloids and adjacent skin before treatment,and post-operation outcome,by using Laser Speckle Contrast Imaging(LSCI).LSCI was used to assess the heterogeneity of different scars,develop personalized treatment plans for patients and improve the keloid treatment system.METHODS:This study included pre-operative and post-operative patients at Peking Union Medical College Hospital from January to April,2018.The first part measured blood perfusion of three regions,keloids(K),skin adjacent to keloids(within 3 mm from the edge of the keloids)(A)and nonadjacent skin(N).Ratios(K/N,A/N)were calculated to represent mean perfusion of keloids and adjacent skin.In the second part,patients were followed up within 1 month,2 months and 3 months after operation,we observed and measured blood perfusion of the wound by LSCI.RESULTS:100 patients with 244 keloids and 13 HTS were enrolled into first part of this study.The mean values(95%confidence intervals)of the ratios were:K/N=2.01(1.94-2.08),A/N=1.79(0.66-2.92)(P<0.001).Keloids can be divided into congested phase,stable phase and remission phase by its perfusion.Keloids on the chest were mostly congested(45.0%),and keloids on the shoulders and back were mostly stable(43.9%),while most of the keloids on the waist,buttocks,and limbs were at remission phase(all more than 43%).K/N of chest keloids from most to least were congested phase(2.35±0.46),stable phase(1.85±0.30),and remission phase(1.53±0.43)(P<0.001);A/N of the chest keloids from most to least were congested phase(1.30±0.30),stable phase(1.15±0.14)and remission phase(1.14±0.19)(P<0.01).Keloids were compared with hypertrophic scars,K/N at keloids was 1.84±0.42,while K/N at HTS was 1.53±0.50(P>0.05);A/N at keloids(1.20±0.90)was higher than that at HTS(1.09±0.10)(P<0.05).In the second part,11 patients were enrolled after surgery and each patient had its characteristics.CONCLUSION:Perfusion in keloids and adjacent skin were significantly higher than that in nonadjacent skin.The keloids blood perfusion was different due to its phase and site.The blood perfusion of keloids and adjacent skin at the congested phase was the highest,then stable phase,and remission phase.The adjacent skin of keloids is higher than that of HTS.LSCI can effectively assess the heterogeneity of the keloids before treatment and evaluate its therapeutic effect after surgery.