Managing Non-healing Surgical Wounds and Surgical Site Infections with Bacterial Fluorescence Imaging: A Case Series

Introduction: Surgical site infection (SSI) is an adverse clinical outcome that significantly drives morbidity resulting in important human and economic burden. This increased burden is associated with prolonged hospitalization, delayed recovery, higher treatment costs, rehospitalization, chronic pain, and disability1-5. Fluorescence imaging has effectively assisted clinicians in detecting high bacterial burden even when not clinically apparent6, supporting timely and objective treat- ment7-8 of non-healing surgical wounds or superficial SSIs. This case series highlights the impact of a handheld fluorescence device on surgical wound treatment and healing. Methods: A cohort of 18 patients with non-healing surgical wounds were treated at a specialized outpatient wound care clinic. These wounds resulted from cosmetic surgeries (n=8), c-sections (n=3), pilonidal sinus excision (n=3), cancer resection (n=2), 1 port-a-cath incision, and 1 toe amputation. Fluorescence wound imaging was performed by a single wound care provider during the patient’s visit using a hand-held, non-contact device* that detects the presence and location of bacterial loads >104 CFU/gr as red or cyan fluorescence signals. Wound area measurements were used to track wound healing progression. The poster showcases the 6 most prominent cases to illustrate wound management. Results: Out of the 18 non-healing surgical wounds imaged, 89% dis- played fluorescence signals indicative of bacteria/biofilm at their baseline/ initial visit. The clinician used this biomarker to guide wound treatment decisions in several ways: 1) fluorescence alerted toward areas not flagged by standard clinical assessment; 2) cleansing/debridement procedures were focused to bacteria-laden areas, avoiding disturbing healthy tissue; 3) the need for further cleansing, debridement or antimicrobials was ascertained post-procedurally. Fluorescence signals fluctuated between visits. By the end of the investigation, complete eradication of fluorescent signals (indicating elevated bioburden) was observed in 100% of cases. Healing was accomplished in 83% of the wounds, and for the 3 wounds that did not heal completely, wound area reduced by 42.2% (average). Discussion: Fluorescence imaging enabled precise removal of bioburden and supported objective care planning, improving infection management, antimicrobial stewardship, and promoting healing in stalled surgical wounds. This non-invasive, handheld technology had a signifi- cantly positive impact on the outcomes of these patients.