The article is part of the special theme issues in the JAMA/Archives journals on medical applications of biotechnology. Because leg ulcers and chronic wounds represent important cost factors for health care systems, with transportation costs representing a large percentage of these costs, telemedical wound care is an potentially important application of teledermatology, the authors suggest.
Ralph Peter Braun, M.D., of University Hospital of Geneva, Switzerland, and his colleagues performed a prospective study comparing face-to-face evaluation of leg wounds with remote evaluations to address the feasibility of taking images with cell phones, transmitting them to an expert at a distance and getting the expert's advice immediately.
Over the course of three months, patients at their outpatient clinic, a total of 52 patients with 61 chronic wounds were evaluated by a physician who also took two images of the leg ulcer, an overview image covering the lower leg and the ulcer and a close-up picture covering the leg ulcer with surrounding skin. The images, taken under normal lighting conditions, were immediately transmitted via the mobile telephone to the e-mail accounts of two physicians who then made the remote diagnoses.
The three physicians separately evaluated the 61 leg ulcers for nine variables. "The image quality was judged to be good in 59 percent of the cases and very good in 12 twelve. The participants felt comfortable making a diagnosis based on the pictures in 82 percent,” the authors state.
"In this study, we were able to show for the first time that telemedicine for chronic wounds is feasible under routine conditions using this new generation of mobile telephones and direct transfer via e-mail,” the authors conclude. "We had the impression that a high percentage of the problems related to leg ulcers could be solved with this type of teleconsultation.”