BOSTON, Mass. -- For Dr. Lynn Drake, a faculty member at Harvard Medical School and the Wellman Center for Photomedicine at Massachusetts General Hospital, both in Boston, partnering with the U.S. military requires a commitment to accuracy and consistency and a forward-leaning mindset.
"We've got about 23 clinical inventions that are now in use worldwide," said Drake, an investigator with the Combat Casualty Care Research Program's photonics portfolio, "plus another 14 platform technologies that have multiple applications, and then I've got another 60 things in our pipeline."
One of those technologies is a cutting-edge fractional laser developed specifically with the military community in mind. In essence, the laser helps to remodel painful scars by creating thousands of tiny holes on the scarred area, which data shows heal faster and cleaner than the original wound.
"Mother Nature gets confused when she tries to heal a bigger wound," Drake said, adding that fractional lasers are used in the medical community to reduce pain, minimize disfigurement and even erase some scars entirely. That same technology might be used for future skin-grafting efforts and other therapies. Devices for this kind of skin grafting have U.S. Food and Drug Administration approval and are commercially available.
The Wellman Center has been partnering with DOD for 20 years, and currently more than 20 percent of its overall efforts are dedicated to the well-being of the warfighter.
The lab is also working to use light to make blood platelets last longer. "The military came in one day and said, 'We need a way of making platelets last longer,'" said Dr. Conor Evans, a faculty member at Wellman. "And so now we have a project underway that we think will extend platelet storage time dramatically."
That research is all the more important given the forecast for future battlefield scenarios where evacuation to external care facilities may not be immediately possible. According to the CCCRP's Hemorrhage Control and Resuscitation portfolio, current investments are geared toward developing an FDA-approved dried plasma product, while the goal for future blood products is to ensure survivability for at least 6 to 12 hours -- a number that jumps to 72 hours for potential prolonged field care scenarios. According to Evans, the early data is "fairly outstanding."
WHEN PHYSICAL, PSYCHOLOGICAL MEET
Back at University of California - Irvine, the conversation grows subdued as it turns to treating burn injuries. While injuries thought to be fatal just a few years ago are no longer considered as such, burns are still complicated by infection and other variables. For Dr. Anthony Durkin, associate professor at the university and the adjoining Beckman Laser Institute and Medical Clinic, relief for burn victims is as much a matter of tissue as it is time.
"Burns are psychologically difficult," said Durkin, an investigator with the CCCRP's photonics portfolio. "Someone who has a burn wants to know as soon as possible whether they're going to need more surgery or not. Plus, the longer you wait to take action, the infection rate goes way up over a few days. The risk of scarring and all the nightmares that go along with scarring go up, too."
According to the current standard of care, it can take up to three days post-burn for laser Doppler imaging, which determines whether the injured tissue is structurally sound enough to be reconstructed. So Durkin's team developed the cutting-edge spatial frequency domain imaging camera to assess the reconstructive potential of the tissue involved in burns and other wounds.
The SFDI camera uses diffuse optical spectroscopy to take a snapshot of an affected burn area, with the resulting image providing an almost real-time visual map of parameters such as oxygen saturation, water content and total hemoglobin for each pixel. Clinicians can then evaluate tissue viability in wounded areas and determine whether that tissue is a suitable candidate for reconstructive surgery, all within just a few hours. "We think we can buy a couple of days that can dramatically decrease the risk of scars and infection," Durkin said.
In addition to being a noninvasive technology, the SFDI can differentiate between superficial partial thickness burns and deep partial thickness burns, a relatively muddy area of wound designation within the medical community, according to Durkin. The SFDI, which is being developed and commercialized by California-based Modulated Imaging Inc., recently received a grant to perform a tissue viability analysis in a variety of wounds relevant to the military. As a result, Durkin's team has received FDA approval for their technology for research purposes and began efforts to secure FDA clearance for a miniature version of the same device at the end of 2017.
SAVING CITIZENS' LIVES, TOO
The fruits of the CCCRP's military medical mission often translate to the civilian world, and the lactate monitor is no exception. "The diabetes community has caught on to what I'm doing," Botvinick said, "and they're very interested in knowing if lactate can help them safely control sugar and exercise routines in diabetes patients."
For as much effort and investment goes into the CCCRP's litany of products and projects, so many of those same efforts -- tourniquets, a balloon-tipped catheter that stops bleeding known as the REBOA and countless knowledge products -- have gone on to improve and save the lives of countless American citizens.
While that is not the stated priority of the CCCRP and its associated technologies, it is a substantial benefit to the taxpaying public. After all, if a resilient military can help develop a resilient population which, in turn, continues to fuel an even more resilient military -- well, that's the very definition of achievement.
For more information, contact Chelsea B. Bauckman at chelsea.b.bauckman.civ@mail.mil or go to http://mrmc.amedd.army.mil/.
MR. RAMIN A. KHALILI serves as the knowledge manager for CCCRP. Before assuming his current role, he spent more than a decade as a broadcast journalist, working in a number of cities across the country. During that time, he earned an Associated Press Award for his work in Phoenix, before securing a position as chief NASA correspondent for CBS in Orlando, Florida. He holds a B.A. in communications from Pennsylvania State University.
(Editor's Note: This is part one of a two-part series. This article will be published in the January -- March 2018 Army AL&T magazine.)
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