Wound Healing After Lancing the Skin
Wound Healing After Lancing the Skin
Diabetic patients lance themselves daily to obtain blood samples for glucose testing, and as reliable devices reach the market, many patients may prefer to test on body sites other than the finger to reduce pain. To date, healing of lancet wounds has not been well studied. This study included seven trials at four locations with 271 total subjects (59 non-diabetic, 212 diabetic) and evaluation of 2707 lancet wounds. A vacuum-lancet device pierced the skin to a depth of 0.4 to 2.1mm with a 28- or 21-gauge lancet. Finger, forearm, abdomen, and thigh sites were characterized using videomicroscopy. The incidence of bruising and redness of the wound was determined by subject self-appraisal using a common photographic reproduction for comparison. Less erythema was measured on the fingertip than on the other body sites. For type 1 and type 2 diabetic subjects across a range of ages, erythema was resolved at 73 to 85 percent of the sites on the forearm on the third day after lancing. The incidence of bruising was higher for female than for male diabetic subjects (6.5% vs. 2.5%). Resolution of the erythema from lancet wounds on the dorsal forearm was similar for a wide range of lancing depths (0.7-2.1mm). The visual disappearance of wounds produced by different gauge lancets was similar. Resolution of erythema secondary to lancing the forearm is typically complete in three days or less; however, considerable site-to-site and person-to-person variations are observed. Lancing body sites other than the finger is likely to become a common practice among diabetic patients.
Since the introduction of home blood glucose testing products, diabetic patients have been performing fingersticks on a daily basis. Lancets in a variety of gauges and automatic lancing devices that control the depth of penetration are commonly available. In general, a blood sample is obtained from the medial or lateral aspect of the 3rd, 4th, or 5th fingertip using gentle pressure from the opposing thumb after lancing. Repeated use of the small area available on the fingertips can toughen the skin over time requiring deeper penetration of the lancet in order to obtain sufficient blood. A well-publicized study showed glucose monitoring at least four times a day in combination with frequent administration of insulin reduces the long-term complications associated with Type 1 diabetes. In order to encourage patients to initiate and comply with regimens that require frequent sampling, the forearm and abdomen have been studied as possible sites for less painful sampling. Body sites other than the fingertips provide a much larger area for testing, are less likely to contact irritating substances or transfer residual blood to other surfaces after testing, and minimize the residual soreness associated with a fingerstick.
Application of vacuum to the skin surrounding a lancet wound has been developed as a reliable means of obtaining capillary blood for glucose monitoring. Healing of the lanced sites after blood extraction by vacuum was studied in order to understand any issues that might discourage diabetic patients from complying with glucose testing recommendations. Lancing body sites other than the finger results in small areas of erythema and an occasional small hematoma. From the perspective of the diabetic patient, the lancet site is healed after resolution of these cosmetic effects. Few studies have reported on the local response secondary to a lancet stick and factors that might influence the visible acceptability of these lancet wounds. Thus, easily accessible sites on the finger, forearm, stomach, and thigh were evaluated in an older and younger population over a period of days to establish the typical time course for disappearance of the erythema. Studies were performed on non-diabetic and diabetic volunteers to understand the effect of lancet gauge and lancet penetration depth. Ultrasound skin thickness and laser Doppler perfusion data were also collected in an attempt to correlate healing with anatomical and physiological factors.
The ultimate goal of our work is the development of a less painful skin lancing device capable of automatic blood sampling and glucose measurement. Characterization of the key factors associated with lancet wound healing and the typical time required for disappearance of the lancet wounds at various body sites is an important consideration for diabetic patients who lance themselves multiple times daily.
Diabetic patients lance themselves daily to obtain blood samples for glucose testing, and as reliable devices reach the market, many patients may prefer to test on body sites other than the finger to reduce pain. To date, healing of lancet wounds has not been well studied. This study included seven trials at four locations with 271 total subjects (59 non-diabetic, 212 diabetic) and evaluation of 2707 lancet wounds. A vacuum-lancet device pierced the skin to a depth of 0.4 to 2.1mm with a 28- or 21-gauge lancet. Finger, forearm, abdomen, and thigh sites were characterized using videomicroscopy. The incidence of bruising and redness of the wound was determined by subject self-appraisal using a common photographic reproduction for comparison. Less erythema was measured on the fingertip than on the other body sites. For type 1 and type 2 diabetic subjects across a range of ages, erythema was resolved at 73 to 85 percent of the sites on the forearm on the third day after lancing. The incidence of bruising was higher for female than for male diabetic subjects (6.5% vs. 2.5%). Resolution of the erythema from lancet wounds on the dorsal forearm was similar for a wide range of lancing depths (0.7-2.1mm). The visual disappearance of wounds produced by different gauge lancets was similar. Resolution of erythema secondary to lancing the forearm is typically complete in three days or less; however, considerable site-to-site and person-to-person variations are observed. Lancing body sites other than the finger is likely to become a common practice among diabetic patients.
Since the introduction of home blood glucose testing products, diabetic patients have been performing fingersticks on a daily basis. Lancets in a variety of gauges and automatic lancing devices that control the depth of penetration are commonly available. In general, a blood sample is obtained from the medial or lateral aspect of the 3rd, 4th, or 5th fingertip using gentle pressure from the opposing thumb after lancing. Repeated use of the small area available on the fingertips can toughen the skin over time requiring deeper penetration of the lancet in order to obtain sufficient blood. A well-publicized study showed glucose monitoring at least four times a day in combination with frequent administration of insulin reduces the long-term complications associated with Type 1 diabetes. In order to encourage patients to initiate and comply with regimens that require frequent sampling, the forearm and abdomen have been studied as possible sites for less painful sampling. Body sites other than the fingertips provide a much larger area for testing, are less likely to contact irritating substances or transfer residual blood to other surfaces after testing, and minimize the residual soreness associated with a fingerstick.
Application of vacuum to the skin surrounding a lancet wound has been developed as a reliable means of obtaining capillary blood for glucose monitoring. Healing of the lanced sites after blood extraction by vacuum was studied in order to understand any issues that might discourage diabetic patients from complying with glucose testing recommendations. Lancing body sites other than the finger results in small areas of erythema and an occasional small hematoma. From the perspective of the diabetic patient, the lancet site is healed after resolution of these cosmetic effects. Few studies have reported on the local response secondary to a lancet stick and factors that might influence the visible acceptability of these lancet wounds. Thus, easily accessible sites on the finger, forearm, stomach, and thigh were evaluated in an older and younger population over a period of days to establish the typical time course for disappearance of the erythema. Studies were performed on non-diabetic and diabetic volunteers to understand the effect of lancet gauge and lancet penetration depth. Ultrasound skin thickness and laser Doppler perfusion data were also collected in an attempt to correlate healing with anatomical and physiological factors.
The ultimate goal of our work is the development of a less painful skin lancing device capable of automatic blood sampling and glucose measurement. Characterization of the key factors associated with lancet wound healing and the typical time required for disappearance of the lancet wounds at various body sites is an important consideration for diabetic patients who lance themselves multiple times daily.
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