Comparative analysis of accuracy and time of calculation of wound surface area using mobile applications

Nikolai O. Mikhailov; Михайлов Николай Олегович; Aleksandr A. Glukhov; Глухов А. А.; Aleksandr A. Andreev; Андреев А. А.; Anastasiya Yu. Laptieva; Лаптиёва А. Ю.; Oleg V. Sudakov; Судаков О. В.; Vladimir Yu. Ivashkov; Ивашков В. Ю.; Aleksandr S. Denisenko; Денисенко А. С.

doi:10.35693/SIM643331

Comparative analysis of accuracy and time of calculation of wound surface area using mobile applications

Authors: Mikhailov N.O.¹, Glukhov A.A.¹, Andreev A.A.¹, Laptieva A.Y.¹, Sudakov O.V.¹, Ivashkov V.Y.², Denisenko A.S.²
Affiliations:
1. Voronezh State Medical University named after N.N. Burdenko
2. Samara State Medical University
Issue: Vol 10, No 2 (2025)
Pages: 161-168
Section: Surgery
Published: 10.06.2025
URL: https://innoscience.ru/2500-1388/article/view/643331
DOI: https://doi.org/10.35693/SIM643331
ID: 643331

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Abstract

Aim – to carry out a comparative assessment of the accuracy and time of calculating the area of the wound surface using mobile applications.

Material and methods. Wound areas were measured using mobile applications +WoundDesk, ImitoWound and V2F in four blocks of the study: schematic 2D image of soft tissue wounds (block I), volumetric (3D) models of wounds in fractures of the shoulder and leg (block II), experimental wounds in laboratory animals (block III) and assessment of combined wound defects upper and lower jaws in patients (IV block). In the first block, four groups were identified: the 1st group was measured by the area of schematic wounds on a flat surface; in the 2nd, 3rd and 4th groups, by the area of schematic wounds painted on cylindrical surfaces with a diameter of 7, 10 and 20 cm, imitating the surfaces of the forearm, shoulder and head, respectively.

Results. In block I, there is a direct relationship between the curvature of the examined wound surface and the accuracy of determining its area. In the second block, the measurements obtained using the ImitoWound mobile application turned out to be the most accurate, 96.22±3.41% and 97.80±2.37%. In the III block of the study conducted on laboratory rats of the Wistar line, the average deviation when using +WoundDesk was 90.84±7.51%, V2F – 88.96±9.52%, ImitoWound – 92.51±2.54%. In the IV block of the study, when analyzing the accuracy of determining the area of defects of superficial soft tissues in patients with facial defects, the ImitoWound mobile application and the Autoplan complex showed similar results.

Conclusion. Most wounds encountered in medical practice have a complex configuration that changes during treatment, changing from one form to another, which calls into question the expediency of using the presented mobile applications as the main method of conducting planimetric studies in medicine.

Keywords

wounds, wound area, planimetry, mobile applications, Autoplan, reconstruction of facial defects

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Introduction

Treatment of soft tissue wounds is one of the costliest items of surgical care worldwide that increases greatly in case of complications [1–3]. The cost of care of patients with this kind of pathology comprises expenses on medications, patient’s stay in the hospital, treatment itself, medical manipulations, rehabilitation, etc. [4]. These facts, as well as high rate of incidence of onset of surgical site infections indicate a necessity of development of new methods of treatment of this condition.

Studies of effectiveness of various methods of treating soft tissue wounds increases the need for an objective assessment of the wound surface area and monitoring the dynamics of defect closure [5–6]. This data is necessary for clinical work, experimental and scientific practice. The calculation of the area of soft tissue defect makes it possible to calculate the amount of dressing material or medications needed to treat the wound surface, which may assist standardization of various surgical procedures or monitor economic efficiency of different methods of treatment [7–9]. Considering the difficulty of planning the reconstructive stage for patients with combined facial defects, this data can be used to calculate the required area of the flap skin paddle to repair defects of skin cover [10, 11]. Given the rapid development of modern technology, there are many IT approaches to the task that are gaining momentum: applications for mobile devices and computer programs including laser grids and three-dimensional scanning [12–16]. The mobile applications generate much interest: patients and doctors have mobile phones, which facilitates remote monitoring of regenerative processes of the wounds [17]. According to the website of the developer of the mobile application ImitoWound, their product is used in more than 30 clinics worldwide¹.

Aim

To carry out a comparative assessment of accuracy and time of calculating the area of the wound surface using mobile applications.

Material and methods

We measured wound surface areas using mobile applications +WoundDesk, ImitoWound and V2F most frequently mentioned in scientific literature [18–22]. To calculate the area, a special target is required that is placed next to the wound, after which a photo is taken with the aid of the application (Fig. 1). In the +WoundDesk application, the target is a 2×2 cm black square on a white background with a centimeter scale on the sides; ImitoWound uses a target sized 1.5×1.5 cm; V2F uses a 1×1 cm white square within a 3×3 cm black square. After capturing the image, the user confirms the contours of the wound defect recognized automatically or makes manual adjustments. After this, the area is calculated, and the data is saved in the patient’s profile or in the history of measurements depending on the functionality of the app.

Figure 1. Measurement of wound surface area using the mobile applications under inquiry.

Рисунок 1. Измерение площади раневой поверхности с использованием исследуемых мобильных приложений.

The study did not include measurements of the depth and the volume of wounds due to the lack of such functions in the apps under inquiry.

When taking photos for subsequent processing with mobile apps, the same distance of 25 cm from the lens to the wound surface was observed, the same positioning of targets to determine scale relative to the wound surface, the defect contours were manually adjusted in all cases, and any foreign objects were removed from the frame. The photos were taken using the Google Pixel 7 mobile phone with Android 14 operating system. The main camera was 50+12 megapixels.

The study was performed in four blocks: schematic 2D image of soft tissue wounds (Block I), three-dimensional (3D) wound models of arm and leg fracture (Block II), experimental wounds in laboratory animals (Block III), and evaluation of combined wound defects of the maxilla and mandible of patients (Block IV).

Block I of the study was performed in four groups. In the first group, areas of wound schemes (WS) on flat surface were measured; in groups two, three and four, the WS were measured drawn on cylindrical surfaces with diameters of 7, 10 and 20 cm simulating the surfaces of the forearm, shoulder and head, respectively.

In each group, subgroups were made which studied the round, oval, square, rectangular, triangular and trapezoidal WS of soft tissues with known area drawn on paper.

The WS area was calculated using L.N. Popova’s method, using the mobile apps +WoundDesk, ImitoWound, V2F. The obtained data were compared with the base area calculated using standard geometric equations: round, 12.5±0.003 cm², oval, 39.2±0.007 cm², square, 4.8±0.002 cm², rectangular, 12.3±0.004 cm², triangular, 13.7±0.006 cm², and trapezoidal, 14.9±0.004 cm².

Among the obtained areas of WS, the average area values were taken as 100% to be used as reference values; after which measurements were performed using mobile apps.

Block II of the study was performed at the multidisciplinary accreditation and simulation center of the N.N. Burdenko Voronezh State Medical University. This block included models of wounds of shoulder fracture (Simulaids compound fracture humerus) and leg amputation wound for accident simulation kit, fragment (Fig. 2).

Figure 2. Models of arm fracture wounds and leg wounds used in the second series of the study.

Рисунок 2. Муляжи ран перелома плеча и раны на ноге, используемых во II серии исследования.

Block III of the study (experimental wounds in laboratory animals) was performed in the Experimental Biology and Medicine Research Institute of the N.N. Burdenko Voronezh State Medical University. For the purposes of the experiment, Wistar line rats were used. The experiment is an addition to the scientific research in various fields whose objectives did not include measurement of wound area; e.g. studies of wounds after laparotomy or thoracotomy access to allow main stages of surgeries. The length of laparotomy wounds was 9.7±1.4 cm, and the length of thoracotomy wound was 4.7±0.5 cm. After the linear incision was made, the edges of the wound were spread out, forming the wound contour of a complex arbitrary shape, and the obtained defect was measured using L.N. Popova’s method, and then using the mobile apps.

Block IV of the study was performed in the Clinics of the Samara State medical University. It involved an analysis of precision of the apps under consideration in the measurement of defects of cover tissues of the head. The range of defects analyzed with the above mentioned apps and the “Autoplan” software suite included defects of the cover tissues of the head of post-traumatic and post-cancer treatment type, and defects of the skin due to post-surgery cicatrical deformations. Some defects had an end-to-end component that was not regarded due to the lack of the respective functionality of the programs. Intra-oral defects of the mucosa were not accounted. Clinical data of 100 patients with combined wound defects of the head were used, including post-cancer treatment (70) and post-traumatic (30) defects of the maxilla and the mandible.

The study is implemented in accordance with the plan of research work of the N.N. Burdenko Voronezh State Medical University within the complex topic “Vital Problems of Prevention and Treatment of Surgical Diseases” (State registration No. 121060700037-3) in compliance with the effective regulations of work with laboratory animals.

The method of L.N. Popova was chosen as the gold standard to evaluate the efficiency of using mobile apps in Blocks II, III and IV of the study due to the high precision of the former not depending on the curvature of the surface [23]. At first, measurements were taken using L.N. Popova’s method, the results of which were taken as 100%, afterwards, the results obtained with mobile apps were compared. The measurement of the wound surface area by L.N. Popova’s method included covering the wound with a transparent sterile millimeter-squared plastic sheet, making an outline of the defect, and manual calculation of its area [24–26].

Block IV of the study used the “Autoplan” software suite, since it is the base of a three-stage algorithm of performance if reconstructive plastic surgeries for patients with combined facial defects.

Statistic processing of obtained data. Methods of descriptive statistics with preliminary assessment of normality of distribution were used both for the accuracy of measurement of wound surfaces using the proposed methods, and for the time required to perform the study: graphical, numerical and quantitative tests (Kolmogorov-Smirnov, Shapiro-Wilk). Calculations were performed of the average value of the obtained results, mean root square deviation, standard error of mean within the studied groups. The first stage included one-way ANOVA. After the differences were identified, the Student’s t-test was applied to identify significance of differences in the samples. The level of validity of obtained result difference was taken to be 5% (p<0.05).

The data processing was performed in the Statictica 10.0 and Microsoft Office Excel 2010 software suites.

The total number of measurements using all suggested methods was 4480 in the four blocks of the study: Block I, 960; Block II, 80; Block III, 1440; Block IV, 2000, respectively. Each wound defect was measured with the mobile apps under inquiry and with the L.N. Popova’s method (Blocks II, III and IV). The obtained results are presented as percent ratios for the following reasons: in the course of the study, we were interested in the accuracy of measurement of the wound surface area with the suggested methods with respect to the original area and to the L.N. Popova’s method, which is the most important factor from the standpoint of looking into the posiibility of using these apps in clinical practice. In Blocks III and IV, 3440 measurements were performed (190 unique wounds). The use of other methods would result is a significant increase of amount of results; the numerical expression of area measurements prevents their graphic interpretation.

Results and discussion

Group 1 of Block I of the study included measurements of WS of soft tissues on a flat surface using the methods under consideration (Table 1).

Table 1. Accuracy of WS measurement on a flat surface in the 1st group of the 1st block of the study in relation to the initial area, %

Таблица 1. Точность измерения СР на плоской поверхности в 1-й группе I серии исследования по отношению к исходной площади, %

WS Type

Mobile apps used to measure WS area

+WoundDesk

V2F

ImitoWound

Round

98.92±6.55

(p1=0.068)

(p3=0.038)

(p4=0.048)

72.05±15.34

(p1=0.024)

(p2=0.038)

(p4=0.045)

92.43±8.82

(p1=0.041)

(p2=0.048)

(p3=0.045)

Oval

98.57±8.32

(p1=0.071)

(p3=0.032)

(p4=0.041)

71.97±13.92

(p1=0.019)

(p2=0.032)

(p4=0.024)

92.5±9.41

(p1=0.034)

(p2=0.041)

(p3=0.024)

Square

79.25±5.17

(p1=0.045)

(p3=0.028)

(p4=0.031)

97.81±9.12

(p1=0.053)

(p2=0.028)

(p4=0.074)

96.25±6.47

(p1=0.026)

(p2=0.031)

(p3=0.074)

Rectangular

74.63±9.24

(p1=0.027)

(p3=0.039)

(p4=0.042)

96.49±5.94

(p1=0.038)

(p2=0.039)

(p4=0.055)

99.47±3.52

(p1=0.078)

(p2=0.042)

(p3=0.055)

Triangular

158.78±4.71

(p1=0.031)

(p3=0.015)

(p4=0.024)

66.9±15.64

(p1=0.022)

(p2=0.015)

(p4=0.026)

93.52±8.10

(p1=0.042)

(p2=0.024)

(p3=0.026)

Trapezoidal

101±4.61

(p1=0.043)

(p3=0.019)

(p4=0.045)

69.53±7.73

(p1=0.029)

(p2=0.019)

(p4=0.023)

92.48±13.75

(p1=0.019)

(p2=0.045)

(p2=0.023)

Notes: р¹ – significance of differences vs. L.N. Popova’s method; p² – significance of differences vs. WoundDesk app; p³ – significance of differences vs. V2F app; p⁴ – significance of differences vs. ImitoWound app.

In the measurement of area of round and oval WS, the +WoundDesk app showed the highest accuracy as compared to other apps, 98.92±6.55% and 98.57±8.32% from the base area, respectively. In the calculation of area of square and rectangular WS, V2F and ImitoWound demonstrated accuracy above 95%. The use of +WoundDesk in the calculation of the area of triangular WS results in a significant overestimation of area, 158.78±4.71% from the base value. The V2F app shows the lowest accuracy, 70%, in the measurement of area of triangular and trapezoidal WS.

In the second group of the study, WS were placed on a cylinder with a diameter of 10 cm to simulate wounds of the shoulder (Table 2).

Table 2. Accuracy of WS measurement on cylindrical surfaces with a diameter of 10 cm, simulating the surface of the shoulder, %

Таблица 2. Точность измерения СР на цилиндрических поверхностях диаметром 10 см, имитирующих поверхность плеча, %

WS Type

Mobile apps used to measure WS area

+WoundDesk

V2F

ImitoWound

Round

97.21±8.44

(p1=0.059)

(p3=0.039) (p4=0.047)

70.15±16.26

(p1=0.020) (p2=0.039)

(p4=0.031)

90.17±13.55

(p1=0.018)

(p2=0.047)

(p3=0.031)

Oval

96.83±5.31

(p1=0.055)

(p3=0.026)

(p4=0.045)

69.34±26.81

(p1=0.024) (p2=0.026)

(p4=0.036)

89.58±14.73

(p1=0.015)

(p2=0.045)

(p3=0.036)

Square

76.32±8.81

(p1=0.034)

(p3=0.041)

(p4=0.028)

93.34±9.48

(p1= 0.017) (p2=0.041)

(p4=0.056)

97.32±5.63

(p1=0.027)

(p2=0.028)

(p3=0.056)

Rectangular

74.27±4.63

(p1=0.029)

(p3=0.048)

(p4=0.023)

89.77±7.29

(p1=0.023)

(p2=0.048)

(p4=0.054)

96.31±7.85

(p1=0.033)

(p2=0.023)

(p3=0.054)

Triangular

161.78±11.52

(p1=0.021)

(p3=0.008)

(p4=0.015)

64.53±28.25

(p1=0.028)

(p2=0.008)

(p4=0.039)

89.44±14.48

(p1=0.035)

(p2=0.015)

(p3=0.039)

Trapezoidal

103.00±4.17

(p1=0.045)

(p3=0.012)

(p4=0.019)

68.71±31.73

(p1=0.025)

(p2=0.012)

(p4=0.017)

87.58±5.83

(p1=0.038)

(p2=0.019)

(p3=0.017)

We see a decrease in accuracy in all of the apps used. At the same time, ImitoWound yielded the average accuracy value above 85% in all subgroups, the use of +WoundDesk in the measurement of square and rectangular WS produces accuracy of 67.51% to 85.13%, and still gives overestimation of the area of triangular defects. V2F demonstrated the greatest mean square root deviation in all groups of the study, and accuracy above 85% was only obtained to square and rectangular WS.

In the third group, WS were placed on a cylinder with the diameter of 7 cm to simulate wounds of the forearm (Table 3).

Table 3. Accuracy of WS measurement on cylindrical surfaces with a diameter of 7 cm, simulating the surface of the forearm, %

Таблица 3. Точность измерения СР на цилиндрических поверхностях диаметром 7 см, имитирующих поверхность

WS Type

Mobile apps used to measure WS area

+WoundDesk

V2F

ImitoWound

Round

96.21±4.14

(p1=0.036)

(p3=0.015)

(p4=0.047)

70.15±19.48

(p1=0.024)

(p2=0.015)

(p4=0.033)

90.17±11.38

(p1=0.031)

(p2=0.047)

(p3=0.033)

Oval

97.14±5.48

(p1=0.047)

(p3=0.011)

(p4=0.042)

69.34±21.22

(p1=0.037)

(p2=0.011)

(p4=0.026)

89.58±8.29

(p1=0.022)

(p2=0.042)

(p3=0.026)

Square

76.32±4.51

(p1=0.029)

(p3=0.022)

(p4=0.044)

93.34±9.27

(p1=0.023)

(p2=0.022)

(p4=0.064)

97.32±7.15

(p1=0.026)

(p2=0.044)

(p3=0.064)

Rectangular

76.83±7.11

(p1=0.031)

(p3=0.040)

(p4=0.037)

89.77±8.35

(p1=0.042)

(p2=0.040)

(p4=0.039)

96.31±4.63

(p1=0.045)

(p2=0.037)

(p3=0.039)

Triangular

158.78±9.52

(p1=0.018)

(p3=0.016)

(p4=0.034)

64.53±24.51

(p1=0.041)

(p2=0.016)

(p4=0.025)

89.44±11.73

(p1=0.037)

(p2=0.034)

(p3=0.025)

Trapezoidal

103±6.18

(p1=0.045)

(p3=0.019)

(p4=0.045)

68.71±31.16

(p1=0.033)

(p2=0.019)

(p4=0.018)

87.58±8.30

(p1=0.043)

(p2=0.045)

(p3=0.018)

With a further decrease in the diameter of the cylindrical surface and an increase in the curvature of the object, the measurement accuracy of the proposed methods continues to decrease. The greatest accuracy in the measurement of WS area is still shown by +WoundDesk for round, oval and trapezoidal WS, V2F for square and rectangular WS, ImitoWound for all types, the average accuracy was 91.73±8.58%.

In the fourth group, WS were placed on a cylinder with the diameter of 20 cm, simulating the surface of the head (Table 4).

Table 4. Accuracy of WS measurement on a spherical surface with a diameter of 20 cm, simulating the surface of the head, %

Таблица 4. Точность измерения СР на сферической поверхности диаметром 20 см, имитирующих поверхность головы, %

WS Type

Mobile apps used to measure WS area

+WoundDesk

V2F

ImitoWound

Round

96.47±4.59

(p1=0.065)

(p3=0.023)

(p4=0.047)

71.05±17.34

(p1=0.029)

(p2=0.023)

(p4=0.034)

91.55±9.19

(p1=0.038)

(p2=0.047)

(p3=0.034)

Oval

95.14±8.74

(p1=0.063)

(p3=0.025)

(p4=0.051)

70.72±21.44

(p1=0.027)

(p2=0.025)

(p4=0.031)

90.34±6.11

(p1=0.031)

(p2=0.051)

(p3=0.031)

Square

76.32±6.04

(p1=0.028)

(p3=0.021)

(p4=0.039)

95.78±7.15

(p1=0.081)

(p2=0.021)

(p4=0.054)

98.03±4.32

(p1=0.062)

(p2=0.039)

(p3=0.054)

Rectangular

74.83±7.41

(p1=0.021)

(p3=0.028)

(p4=0.033)

90.74±5.29

(p1=0.026)

(p2=0.028)

(p4=0.041)

98.61±3.24

(p1=0.059)

(p2=0.033)

(p3=0.041)

Triangular

158.78±5.12

(p1=0.016)

(p3=0.014)

(p4=0.042)

65.56±28.42

(p1=0.035)

(p2=0.014)

(p4=0.025)

90.76±9.01

(p1=0.027)

(p2=0.042)

(p3=0.025)

Trapezoidal

102.00±4.15

(p1=0.072)

(p3=0.020)

(p4=0.047)

69.97±31.13

(p1=0.038)

(p2=0.020)

(p4=0.039)

90.82±7.92

(p1=0.025)

(p2=0.047)

(p3=0.039)

We observe an increase in the accuracy of measurement results in this group in comparison with the first and third groups of Block I of the study; this relates to a lower curvature of the object. In comparison with the third group, we see a minor increase in accuracy of the value in question. Therefore, there is a direct correlation between the curvature of the examined wound and the accuracy of measurement of its area. It follows from the obtained results that the ImitoWound app is the all-purpose tool to perform planimetry measurements of wound schemes thanks to its high accuracy, which is 92.81±6.52%, on average.

Block II of the study is performed on wound models of shoulder and leg fractures. Using L.N. Popova’s method to measure the area of the soft tissue defects, we obtained the following measurement results 34.7±1.2 cm² and 9.5±0.8 cm², respectively. After this, measurements were taken using other methods (Table 5).

Table 5. Accuracy of determining the area of wound models for shoulder and leg fractures, %

Таблица 5. Точность определения площадей муляжей ран при переломе плеча и на ноге, %

Model type	L.N. Popova’s method	Mobile apps used to measure WS area
Model type	L.N. Popova’s method	+WoundDesk	V2F	Imito Wound
Wound in shoulder fracture	100%	86.83±12.74 (p1=0.039) (p3=0.045) (p4=0.041)	70.86±18.11 (p1=0.022) (p2=0.045) (p4=0.027)	96.22±8.05 (p1=0.061) (p2=0.041) (p1=0.027)
Leg wound	100%	85.26±9.13 (p1=0.042) (p3=0.057) (p4=0.044)	82.21±15.62 (p1=0.031) (p2=0.057) (p4=0.043)	97.80±7.46 (p1=0.065) (p2=0.044) (p3=0.043)

In both models, the measurements taken with the ImitoWound app had the highest accuracy: 96.22±8.05% and 97.80±7.46%. +WoundDesk and V2F yielded the accuracy of 86.83±12.74% and 70.86±18.11% for the model of the shoulder fracture wound and 85.26±9.13% and 82.21±15.62% for the model of the leg wound, respectively.

In Block III of the study performed on Wistar line laboratory rats, the average deviation when using +WoundDesk was 90.84±9.48%, V2F, 88.96±13.41%, and ImitoWound, 92.51±6.94% (Table 6). Another important parameter was the time required to perform the measurements: the +WoundDesk app required the least time, because manual adjustment of outlines requires matching of a lower number of defect boundary to identify it.

Table 6. Accuracy and time of measuring wound areas using L.N. Popova’s method and mobile applications in Wistar laboratory rats in the III block of the study, %

Таблица 6. Точность и время измерения площадей ран методом Л.Н. Поповой и с использованием мобильных приложений у лабораторных крыс линии Wistar в III серии исследования, %

L.N. Popova’s method

+WoundDesk

V2F

ImitoWound

Accuracy of mound area measurement, %

100%

90.84±9.48

(p1=0.041)

(p3=0.066)

(p4=0.053)

88.96±13.41

(p1=0.023)

(p2=0.066)

(p4=0.081)

92.51±6.94

(p1=0.021)

(p2=0.053)

(p3=0.081)

Time required for measurement, min

3.05

±0.22

0.67

±0.07

0.98

±0.15

1.11

±0.12

In Block IV of the study, the following average deviations were registered in the analysis of accuracy of the measurement of the area of superficial defects of facial soft tissue using the mobile apps and the “Autoplan” software suite: +WoundDesk, 89.86±10.31%, V2F, 86.56±18.94%, ImitoWound 91.34±9/52%, Autoplan, 91.48±10.14% (Table 7).

Table 7. Accuracy of determining the area of defects in superficial soft tissues in patients with facial defects using mobile applications and the Autoplan software, %

Таблица 7. Точность определения площади дефектов поверхностных мягких тканей у пациентов с дефектами лица с использованием мобильных приложений и программного комплекса «Автоплан», %

L.N. Popova’s method

+WoundDesk

V2F

ImitoWound

Autoplan

Defects of the maxilla and mandible

100%

89.86±10.31

(p1 = 0.025)

(p3 = 0.062)

(p4=0.054)

(p5=0.081)

86.56±18.94

(p1 = 0.031)

(p2 = 0.062)

(p4 = 0.055)

(p5 = 0.073)

91.34±9.52

(p1 = 0.029)

(p2 = 0.054)

(p3 = 0.055)

(p5 = 0.063)

91.48±10.14

(p1 = 0.025)

(p2 = 0.081)

(p3 = 0.073)

(p4 = 0.063)

Notes: р¹ – significance of differences vs. L.N. Popova’s method;

p² – significance of differences vs. WoundDesk app;

p³ – significance of differences vs. V2F app;

p⁴ – significance of differences vs. ImitoWound app;

p⁵ – significance of differences vs. Autoplan software suite..

Conclusions

The results of measuring the area of wounds using the studied mobile applications in conditions close to ideal in terms of illumination, distance from the object and camera fixation, which is not always feasible in clinical conditions, often differ significantly from the actual sizes of defects and depend on their shape and degree of curvature of the surfaces.

In Block I of the study, the +WoundDesk app showed the lowest accuracy in the measurement of area of square, rectangular and triangular wound schemes; the V2F app showed low accuracy in round, oval, triangular and trapezoidal wound schemes. The most accurate average results in measurements of different wounds were produced in the ImitoWound app.

The analysis of accuracy of measurement of wound areas on models showed that the +WoundDesk app yielded better results than V2F, however, they reliably differ from the values obtained by the L.N. Popova’s method, by 14.27±7.51% and 21.85±13.85% on average, respectively.

The most accurate app to measure wound area in laboratory animals was ImitoWound showing 92.51±5.93% from the values obtained by the L.N. Popova’s method. The +WoundDesk and V2F apps measure the wound area with the accuracy of 90.84±12.77% and 88.96±15.36%, respectively.

It has been proven that most of the results we obtained differ significantly from the known initial area (Block I) and the area measured by the L.N. Popova’s method (Blocks II, III and IV), which calls into question the appropriateness of using the presented mobile apps as the main method of conducting planimetric studies in medicine, since most wounds encountered in medical practice have a complex configuration that changes during treatment, changing from one shape to another.

In calculating the area of wound surfaces in patients with defects of the upper and lower jaws, the ImitoWound mobile app shows a similar result to the Autoplan software suite, however, the latter has significantly greater potential in planning and performing reconstructive plastic surgeries in patients with head defects, and therefore it can be recommended for use in assessing these defects.

Based on the conducted research, it is obvious that both the development of new methods or applications for calculating the area of the wound defect and the refinement of existing algorithms are required. A possible alternative to the studied mobile apps could be the laser grid and 3D scanning; however, these methods are complicated for use in practical healthcare, which leaves the L.N. Popova’s method the main tool for planimetric studies.

ADDITIONAL INFORMATION	ДОПОЛНИТЕЛЬНАЯ ИНФОРМАЦИЯ
*Study funding.* The study was the authors’ initiative without external funding.	*Источник финансирования.* Работа выполнена по инициативе авторов без привлечения финансирования.
*Conflict of interest.* The authors declare that there are no obvious or potential conflicts of interest associated with the content of this article.	*Конфликт интересов.* Авторы декларируют отсутствие явных и потенциальных конфликтов интересов, связанных с содержанием настоящей статьи.
*Compliance with Ethical Standards.* The authors confirm that the rights of the people who participated in the study were respected, including obtaining informed consent.	*Соответствие нормам этики.* Авторы подтверждают, что соблюдены права людей, принимавших участие в исследовании, включая получение информированного согласия.
*Contribution of individual authors.* Mikhailov N.O., Laptieva A.Yu., Denisenko A.S.: conducting of the research, writing of the text, preparation and analysis of literature. Glukhov A.A., Andreev A.A., Ivashkov V.Yu.: creation of research design, scientific editing. Sudakov O.V.: statistical data processing. All authors gave their final approval of the manuscript for submission, and agreed to be accountable for all aspects of the work, implying proper study and resolution of issues related to the accuracy or integrity of any part of the work.	*Участие авторов.* Михайлов Н.О., Лаптиёва А.Ю., Денисенко А.С. – проведение исследования, написание текста, подготовка и анализ литературы. Глухов А.А., Андреев А.А., Ивашков В.Ю. – создание дизайна исследования, научное редактирование. Судаков О.В. – статистическая обработка данных. Все авторы одобрили финальную версию статьи перед публикацией, выразили согласие нести ответственность за все аспекты работы, подразумевающую надлежащее изучение и решение вопросов, связанных с точностью или добросовестностью любой части работы.