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Determining the Effectiveness of Sharp Debridement Using
Wound/Periwound Bacterial Autofluorescence Imaging
Dr. Stephan Landis MD, FRCP(C)
Department of Hospital Medicine, Ambulatory Wound Clinic / Waterloo-Wellington CCAC Clinic, Guelph General Hospital. Guelph, Ontario, Canada
Background
• Sharp debridement (SD) is
the “gold standard” of wound
debridement
• Even in skilled hands, it is unclear
as to how effective SD is, or what
results should be expected postprocedure.
• Mapping red/orange bacterial
fluorescence (BF) within a wound
is a new technique to visualize
microorganisms within the
wound/periwound, pre- and postdebridement.
Results
• 60 wounds in 28 clinic patients were studied using the
handheld bacterial fluorescence camera
• 16 patients had single ulcers, 12 patients had 2-4 ulcers
• Types of ulcers: Venous: 16, Diabetes: 5, Lymphedema: 3,
Pressure/PVD/Trauma: 4
• 2 patients with multiple ulcers were seen 3x/week
• Evaluation of pre-debridement wounds:
• 1)White light picture for visual standard of bedside
debridement care
Aim
Methods
• White light pre- and postdebridement pictures recorded
as a common visual standard of
bedside debridement care.
• Wound/periwound BF pictures,
pre-debridement, were stratified by
BF intensity:
• A: No red BF present
• B: BF just detectable
• C: Moderate BF, multiple
areas
• D: Areas of BF confluence
• A: 26, B: 13, C: 9, D: 12
• Evaluation of post-debridement wounds:
• 1) White light picture for visual standard of bedside
debridement care
• 2) Persistent BF by pre-debridement category: no
change (3) or increased BF (4):
• A: 14/26 (54%), B: 10/13 (77%),
•
• To assess the effectiveness of sharp debridement using “real-time”
fluorescence imaging to evaluate pre- and post-sharp debridement
technique and BF patterns in a 3-month case study of community clinic
patients with chronic wound ulcers.
• Each patient had white light and
BF pictures taken pre- and postdebridement using a handheld
bacterial fluorescence camera; a
circular curette blade was used
for tissue removal of the wound/
periwound.
• 2) Numbers of pre-debridement ulcers stratified by BF
intensity:
• Wound/periwound BF pictures,
post-debridement, were stratified
by BF intensity:
• 1: No red BF after
debridement
• 2: Less BF than predebridement
• 3: No change in BF
distribution
• 4: More apparent BF after
debridement
Category A
• C: 8/9 (88%), D: 5/12 (41%)
Category B
Category C
Category D
Pre-Debridement
White Light/Auto-Fluorescence
Post-Debridement
White Light/Auto-Fluorescence
• Each white light post-debridement wound/periwound was deemed appropriately debrided by expert opinion
• When compared to post-debridement BF, 41-88% of wound/periwound areas still showed presence of BF: i.e. no
change in BF distribution, or more BF after debridement
Conclusions
• Fluorescence imaging is an easy way to measure bacterial
load in the wound/periwound.
• White light photos confirm that bedside debridement of wound
centre and edges has been performed and deemed clinically
appropriate in real-time.
• Mapping the wound using BF suggests that the periwound
is populated with bacteria in multiple planes and peripheral
lacunae which are not always amenable to complete removal.
• Persistent bacteria in the wound/periwound represent the
visually dynamic microbial-host boundary that represents
local wound infection, critical colonization or healing,
depending upon the direction of the wound-healing trajectory.
• Longitudinal studies need to be performed on “targeted”
debridement to determine whether selective removal of
lacunae of bacterial persistence correlate with more rapid
healing.