WoundAmbit: Bridging State-of-the-Art Semantic Segmentation and Real-World Wound Care

Abstract: Chronic wounds affect a large population, particularly the elderly and diabetic patients, who often exhibit limited mobility and co-existing health conditions. Automated wound monitoring via mobile image capture can reduce in-person physician visits by enabling remote tracking of wound size. Semantic segmentation is key to this process, yet wound segmentation remains underrepresented in medical imaging research. To address this, we benchmark state-of-the-art deep learning models from general-purpose vision, medical imaging, and top methods from public wound challenges. For a fair comparison, we standardize training, data augmentation, and evaluation, conducting cross-validation to minimize partitioning bias. We also assess real-world deployment aspects, including generalization to an out-of-distribution wound dataset, computational efficiency, and interpretability. Additionally, we propose a reference object-based approach to convert AI-generated masks into clinically relevant wound size estimates and evaluate this, along with mask quality, for the five best architectures based on physician assessments. Overall, the transformer-based TransNeXt showed the highest levels of generalizability. Despite variations in inference times, all models processed at least one image per second on the CPU, which is deemed adequate for the intended application. Interpretability analysis typically revealed prominent activations in wound regions, emphasizing focus on clinically relevant features. Expert evaluation showed high mask approval for all analyzed models, with VWFormer and ConvNeXtS backbone performing the best. Size retrieval accuracy was similar across models, and predictions closely matched expert annotations. Finally, we demonstrate how our AI-driven wound size estimation framework, WoundAmbit, is integrated into a custom telehealth system.