The Use of an Advanced Fluorescence Imaging System to Target Wound Debridement, Decrease Bioburden, Improve Healing Rates, and Provide Positive Revenues in an Outpatient Wound Care Setting

Introduction: Optimal wound bed preparation consists of regular debridement to remove devitalized tissues, reduce bacterial load, and establish an environment that can promote healing. A novel point-of-care fluorescence imaging system aids in bacterial-targeted debridement and bio-burden management in the treatment of chronic wounds. This observational case series investigated use of this imaging device to target debridement and promote wound healing.

Methods: Eleven lower extremity chronic wounds were imaged weekly with the device for (1) bacterial fluorescence and (2) wound area over 12 weeks or until healing or lost follow-up. Images positive for bacterial fluorescence (regions of red or cyan) were used to guide debridement to those specific regions. Data from each assessment were categorized as fluorescence positive assessments or fluorescence negative assessment and slopes of wound area weekly % changes were calculated from linear regressions for each categorization.  

Results: Six out of 11 wounds healed during this 12-week assessment. At week 1, average wound area was 8.1 cm² and 10/11 wounds exhibited red fluorescence. Bacterial fluorescence persisted, on average, for 3.7 weeks, and no wounds healed or entered a healing trajectory while red fluorescence was present. Information gained from fluorescence images provided information to better debride the affected area to the appropriate level. In 9% of cases, this additional debridement resulted in a higher billing code. On average, weekly % change in wound area increased (6.5 ± 10.8) during periods with bacterial fluorescence and significantly decreased (-27.7 ± 10.1, p=0.048) once targeted debridement and other treatments had eliminated the fluorescing bacteria.

Conclusions: Results suggest fluorescence information had a beneficial effect on reducing bacterial load and promoting wound healing. This case series suggests incorporation of fluorescence guidance into standard of care could result in healing trajectories, improved patient outcomes, more appropriate treatment, and increased revenues in the outpatient wound centers.