Improved Outcomes in Surgical Reconstruction of Skin Defects: A Case Series Utilizing Fluorescence Imaging for Infection Management and Wound Bed Preparation

Introduction: Surgical reconstruction for chronic wounds requires meticulous wound bed preparation to minimize postoperative com- plications. Non-viable tissues, bacteria, and biofilms must be removed to prevent post-operative infections. Traditional methods of wound assessment frequently fail to identify bacteria and biofilms1,2, and historically post-operative infection rates can reach up to 50%3, often leading to prolonged healing times. Point-of-care fluorescence imaging (MolecuLight®) has emerged as a promising tool for real-time infection detection and management, potentially improving outcomes in skin and soft tissue reconstruction. This technology detects and highlights bacterial presence above 104 CFU/gr in biofilm or planktonic form. This case series aims to evaluate the impact of intraoperative fluorescence imaging-guided wound bed assessment and preparation in surgical reconstruction with a focus on minimizing postoperative complications and improving healing rates. Methods: We present 5 challenging cases of chronic complex, wound candidates for that presented for surgical reconstruction. These included: Pressure ulcer on trunk n=2, VLU n=1, DFU n=1, Non-healing surgical wound on abdomen n=1. Intraoperative fluorescence imaging was performed in all 5 cases pre and post excisional debridement to monitor bacterial presence and location. The time to heal and incidence of postoperative complications, including post-operative infections, were measured. Results: The intraoperative use of fluorescence imaging helped confirm the adequacy of surgical debridement regarding the presence of bacteria and prompted additional intraoperative excision in 3 of the 5 cases. In all 5 cases surgical healing progressed with no post operative infection. The pressure ulcer surgical reconstructions (n=2) healed without incident. The VLU, DFU, and non-healing surgical wound of the abdomen healed by secondary intention without further surgical intervention. Postoperative complications, particularly infection-related issues such as dehiscence, wound breakdown or surgical site infections, were 0%. Discussion: Intraoperative use of fluorescence imaging using Molec- uLight is a valuable adjunct in the surgical management of skin defects to help reduce postoperative complications. By objectively assessing the wound bed and confirming the adequacy of wound bed preparation, fluo- rescence imaging enables more complete bacterial removal and may lead to more successful surgical intervention. Further investigation in larger, controlled studies is needed.