Advancing Pyoderma Gangrenosum Wound Care Through Fluorescence-Guided Debridement

Introduction: Pyoderma gangrenosum (PG) is a cutaneous ulcerative condition associated with autoimmune disease, exhibiting pathergy in 30% of patients. Trauma exacerbates PG lesions, which may clinicians opt to avoid the essential benefits of debridement. However,  targeted fluorescence-guided debridement offers the possibility to perform selective and targeted debridement, minimizing surgical trauma. It has significantly greater sensitivity in bedside bacterial burden detection compared to clinical assessment alone and may enhance outcomes for PG patients as evidenced in other wound types.Methods:This multi-site case series of eight patients illustrates the benefits of conservative, precisely targeted debridement of PG lesions guided by bedside fluorescence imaging* of bacteria. PGs have a notable erratic clinical course, but the effects of minimizing surgical trauma better may yield better outcomes including faster healing and fewer exacerbations.Results:Eight patients underwent rigorous monitoring, averaging once per week, across two specialized wound care clinics in New York and Washington state. Initial assessments detected bacterial fluorescence positivity in all patients, despite an absence of overt clinical signs of infection. By employing a comprehensive strategy involving targeted debridement and topical interventions, significant progress was observed in all cases, evidenced by a notable reduction in wound area and the absence of bacterial fluorescence.Discussion: The fluorescence imaging device visualized pathogenic bacterial loads in real-time, enabling precise and conservative debridement—a crucial step in initiating the healing cascade according to TIME management principles. All patients demonstrated wound area reduction or complete healing, highlighting the effectiveness of this conservative approach in mitigating PG-associated pathergy. While literature reports improved outcomes with fluorescence imaging in treatment selection, including debridement guidance in other wound types, this case series represents the first focused examination of PG. Fluorescence imaging serves as a valuable bedside tool for enabling conservative, minimally traumatic debridement, applicable to PG and various other patient conditions requiring conservative tissue removal.References: