This proposal focuses on the use of multimodal imaging and spectroscopy of post-traumatic soft tissue and bone to assess wound healing. Combining infrared (IR) imaging, near-infrared spectroscopic (NIRS) imaging, and visible reflectance spectroscopic (VRS) imaging with Raman spectroscopy (RS) will enable the surgeon to probe the tissue with a two-dimensional, real-time approach. This assessment allows for optimal determination of the viability of damaged tissue, the suitability of the tissue environment for healing, the potential for wound infection and ectopic bone formation based on the degree of tissue compromise, and development of potential objective indicators for early limb salvage versus amputation. These imaging systems are currently available and readily applicable for clinical use. Combining these technologies in a multimodal system holds great promise in permitting the surgeon to make a better objective assessment of the viability of tissues in ways that have not previously been possible.

Casualties in Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) have experienced a high rate of extremity injuries with nearly ubiquitous diffuse tissue damage and compromised local circulation often associated with overt vascular injury. These injuries include traumatic amputations; open fractures; crush injuries; burns; acute vascular disruption; blastwave-associated pressure injuries; air, thrombotic, and fat embolism; and compartment syndrome. In the treatment of such complex traumatic injuries, improved assessment of global and regional perfusion, extent of infection, location and development of necrotic tissue, as well as location and development of early heterotopic ossification would facilitate the resuscitation and definitive treatment of these patients. Noninvasive spectroscopic methods might fulfill such a role, particularly RS, IR imaging, NIRS imaging, and VRS imaging. These technologies are capable of monitoring tissue temperature, perfusion, and associated hypoxia, collagen deposition, and development of calcified tissue.

Much of the information gained with the use of spectroscopy and spectroscopic imaging techniques, such as IR, NIRS, VRS, and RS, to assess military injuries can also be used to assist civilian medical trauma teams. While the occurrence of injuries involving mangled limbs may not be common at a civilian medical center, the challenges of accurately assessing extremity injuries remain. As with other wounds, IR, NIRS, and VRS imaging with RS would provide information on global and regional perfusion, extent of infection, location, and development of necrotic tissue, providing a more accurate diagnosis of the wound and possibly even prediction of healing times. The proposed technologies pose little, if any, risk; their previous utilization in human cases has demonstrated their safety in a clinical setting.

Multimodal imaging and spectroscopy will allow faster and more accurate diagnosis and treatment regimens. Improved objective assessment of combat wounds would be conducive to improved treatment of the wounds which may result in faster healing times, decreased infection rates, and decreased local and systemic complications of injury. This, in turn, will produce improved clinical outcomes and decreased patient morbidity, resulting in earlier return to duty, improved injured war fighter quality of life, and reduced medical costs.