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Helping Clinicians Save more Burn Victims - By : Adrien Desbois, Jacques De Guise, Isabelle Perreault,

Helping Clinicians Save more Burn Victims


Adrien Desbois
Adrien Desbois Author profile
Adrien Desbois is studying for a double Ph.D. degree at the Department of Healthcare Technology at the ÉTS. He holds an engineering degree from France, and is conducting a Ph.D. at the Imaging and Orthopaedics Laboratory.

Jacques De Guise
Jacques De Guise Author profile
Jacques de Guise is a full professor at the Department of automated manufacturing engineering at the ÉTS and associate professor at the Department of surgery of the Université de Montréal faculty of medicine.

Isabelle Perreault
Isabelle Perreault Author profile
Dr. Isabelle Perreault is a plastic surgeon specializing in burn victims at the Hôtel-Dieu de Montréal, and her practice focuses on acute care to burn victims and secondary reconstruction of the after-effects of serious burns.

burn

Burns are an exceptional case of aggression on the human body, Grands brûlésinvolving many metabolic alterations. They can be both physically and psychologically devastating, and no nation or people is spared. Burns sufficiently severe to require medical treatments affect almost 11 million people with more than 300,000 deaths each year, around the world. The impact of the burns is higher than tuberculosis and HIV infections combined [1].

During initial management of a patient with major burn injuries, shortly after admission to the hospital, the size of the burns is established. Major burn injuries involve important fluid loss, which must be replaced to maintain body homeostasis of the body and ensure the survival of the patient. The amount of replacement fluid the patient requires to survive depends on the RBSA, the ratio of the burned body surface area to the total body surface area (TBSA). Clinicians proceed to a visual estimation on 2D (two dimensions) diagrams to assess this percentage (RBSA).

burn

Figure 1 Example of 2D clinical methods. Left: Rule of “nines”. Right: Lund-Browder diagram.

However, these “pen-and-paper” methods can over or under-estimate the replacement fluid required, due to morphological variations of the patients and the variability among observers [3] [4] [5] [6]. This is even more critical in the case of children or frequent clinical situations such as patients with central obesity [7]. Moreover, errors in assessing the RBSA can lead to significant medical and surgical complications [6] [8], and in some cases the patient’s death.

To address this shortcoming, some authors [9] [10] have proposed representing burns in 3D (three dimensions) to better assess the RBSA. However, the 3D models offered by these software are not representative of a patient’s actual constitution and, therefore, introduce errors in the RBSA calculation. They do not take into account the correlation between different human body parts, typical features, and different human morphologies that can make a big difference to the RBSA.

In order to optimize initial management of patients with major burn injuries, we propose to design and validate a numerical method allowing the quantified assessment of burned body surface areas from a 3D modeling of the total body, based on a limited set of anthropometric measurements.

Working cooperatively with a team of experts in surgery for patients with major burn injuries, this original method will be part of the clinical process by taking into account the clinical requirements. From a limited set of anthropometric measures taken on the patient, the clinicians will be able to create a 3D personalized model of the patient’s constitution. With a 3D model adapted to the patient, the RBSA will be accurately assessed by “drawing” the burned areas directly on the model (Figure 2).

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Figure 2 Structure of the proposed method

The 3D modeling of the personalized models will be performed by an easy to use interface based on the MakeHuman [11] software, whereas the assessment of the RBSA will be performed by a 3D rendering interface. This quick and easy cross-platform tool (Figure 3) will allow a better initial management which could make the difference between avoidable debilitating sequels and a good outcome.

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Figure 3 The RBSA assessment tool developed for this project

This tool will be validated in real clinical conditions of use on real patients.

The clinicians will have a tool to help them plan the treatment of the patients, which should allow to reduce assessment errors, particularly when patients have particular morphologies. The intended impacts are reducing medical complications due to a sub-optimal assessment, shortening hospital stays and optimizing care of patients with major burn injuries.

This tool could also be applied to the assessment of traumas, surface problems such as scars, skin disease, wounds and any other surface lesions.

Adrien Desbois

Author's profile

Adrien Desbois is studying for a double Ph.D. degree at the Department of Healthcare Technology at the ÉTS. He holds an engineering degree from France, and is conducting a Ph.D. at the Imaging and Orthopaedics Laboratory.

Program : Automated Manufacturing Engineering  Healthcare Technology 

Research chair : Canada Research Chair on 3D Imaging and Biomedical Engineering 

Research laboratories : LIO – Imaging and orthopedics research laboratory 

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Jacques De Guise

Author's profile

Jacques de Guise is a full professor at the Department of automated manufacturing engineering at the ÉTS and associate professor at the Department of surgery of the Université de Montréal faculty of medicine.

Program : Automated Manufacturing Engineering 

Research chair : Canada Research Chair on 3D Imaging and Biomedical Engineering  Marie-Lou and Yves Cotrel Montreal University and ÉTS Research Chair in Orthopaedics 

Research laboratories : LIO – Imaging and orthopedics research laboratory 

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Isabelle Perreault

Author's profile

Dr. Isabelle Perreault is a plastic surgeon specializing in burn victims at the Hôtel-Dieu de Montréal, and her practice focuses on acute care to burn victims and secondary reconstruction of the after-effects of serious burns.

Author profile


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