Use of a bacterial fluorescence imaging system to target wound debridement and accelerate healing: a pilot study

2020 ◽  
Vol 29 (Sup7) ◽  
pp. S44-S52 ◽  
Author(s):  
Windy Cole ◽  
Stacey Coe
Keyword(s):  
Wound Healing ◽  
Fluorescence Imaging ◽  
Imaging System ◽  
Wound Care ◽  
Point Of Care ◽  
Bacterial Load ◽  
Case Series ◽  
Wound Area ◽  
Wound Debridement ◽  
Wound Bed Preparation

Objective: Optimal wound-bed preparation consists of regular debridement to remove devitalised tissues, reduce bacterial load, and to establish an environment that promotes healing. However, lack of diagnostic information at point-of-care limits effectiveness of debridement. Method: This observational case series investigated use of point-of-care fluorescence imaging to detect bacteria (loads >104CFU/g) and guide wound bed preparation. Lower extremity hard-to-heal wounds were imaged over a 12-week period for bacterial fluorescence and wound area. Results: A total of 11 wounds were included in the study. Bacterial fluorescence was present in 10 wounds and persisted, on average, for 3.7 weeks over the course of the study. The presence of red or cyan fluorescent signatures from bacteria correlated with an average increase in wound area of 6.5% per week, indicating stalled or delayed wound healing. Fluorescence imaging information assisted in determining the location and extent of wound debridement, and the selection of dressings and/or antimicrobials. Elimination of bacterial fluorescence signature with targeted debridement and other treatments correlated with an average reduction in wound area of 27.7% per week (p<0.05), indicative of a healing trajectory. Conclusion: These results demonstrate that use of fluorescence imaging as part of routine wound care enhances assessment and treatment selection, thus facilitating improved wound healing.

Punch Grafting for the Management of Hard-to-Heal Diabetic Foot Ulcers: A Prospective Case Series

2021 ◽  
pp. 153473462110310
Author(s):  
Marta García-Madrid ◽  
Irene Sanz-Corbalán ◽  
Aroa Tardáguila-García ◽  
Raúl J. Molines-Barroso ◽  
Mateo López-Moral ◽  
...  
Keyword(s):  
Wound Healing ◽  
Clinical Outcomes ◽  
Diabetic Foot ◽  
Donor Site ◽  
Case Series ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Wound Debridement ◽  
Prospective Case Series

Punch grafting is an alternative treatment to enhance wound healing which has been associated with promising clinical outcomes in various leg and foot wound types. We aimed to evaluate the clinical outcomes of punch grafting as a treatment for hard-to-heal diabetic foot ulcers (DFUs). Six patients with chronic neuropathic or neuroischemic DFUs with more than 6 months of evolution not responding to conventional treatment were included in a prospective case series between May 2017 and December 2020. All patients were previously debrided using an ultrasound-assisted wound debridement and then, grafted with 4 to 6 mm punch from the donor site that was in all cases the anterolateral aspect of the thigh. All patients were followed up weekly until wound healing. Four (66.7%) DFUs were located in the heel, 1 (16.7%) in the dorsal aspect of the foot and 1 (16.7%) in the Achilles tendon. The median evolution time was 172 (interquartile range [IQR], 25th-75th; 44-276) weeks with a median area of 5.9 (IQR; 1.87-37.12) cm2 before grafting. Complete epithelization was achieved in 3 (50%) patients at 12 weeks follow-up period with a mean time of 5.67 ± 2.88 weeks. Two of the remaining patients achieved wound healing at 32 and 24 weeks, respectively, and 1 patient showed punch graft unsuccessful in adhering. The median time of wound healing of all patients included in the study was 9.00 (IQR; 4.00-28.00) weeks. The wound area reduction (WAR) at 4 weeks was 38.66% and WAR at 12 weeks was 88.56%. No adverse effects related to the ulcer were registered through the follow-up period. Autologous punch graft is an easy procedure that promotes healing, achieving wound closure in chronic DFUs representing an alternative of treatment for hard-to-heal DFUs in which conservative treatment has been unsuccessful.

scholarly journals Guidelines for Point-of-Care Fluorescence Imaging for Detection of Wound Bacterial Burden Based on Delphi Consensus

Diagnostics ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 1219
Author(s):  
Alisha R. Oropallo ◽  
Charles Andersen ◽  
Raymond Abdo ◽  
Jenny Hurlow ◽  
Martha Kelso ◽  
...  
Keyword(s):  
Wound Healing ◽  
Fluorescence Imaging ◽  
Nurse Practitioners ◽  
Point Of Care ◽  
Clinical Signs ◽  
Care Providers ◽  
Bacterial Burden ◽  
Term Care ◽  
Assessment Protocol ◽  
Treatment Plans

Excessive levels of bacteria impede wound healing and can lead to infectious complications. Unfortunately, clinical signs and symptoms of elevated bacterial burden are often unreliable. As a result, point--of--care fluorescence imaging, used to detect critical bacterial burden in wounds, is becoming widely recognized and adopted by clinicians across the globe as an accepted and added component of wound assessment protocol. A Delphi method was employed to establish consensus guidelines describing fluorescence imaging use. A multidisciplinary panel of 32 wound experts (56% MD, 22% podiatrist, 12.5% nurses/nurse practitioners) representing multiple sites of service (e.g., hospital outpatient, inpatient, private office, long-term care) completed two rounds of online questionnaires. The Delphi included key topics, including competencies required to perform imaging, clinical indications for imaging (e.g., signs/symptoms present, procedures warranting imaging), frequency of imaging, and a clinical workflow algorithm. Describing their clinical experiences of imaging impact, >80% reported changes in treatment plans, 96% reported that imaging-informed treatment plans led to improved wound healing, 78% reported reduced rates of amputations, and 83% reported reduced rates of microbiological sampling. The guidelines provided here will help to standardize use of fluorescence imaging among wound care providers and enhance the quality of patient care.

scholarly journals PENGARUH PENGGUNAAN ASI PADA PERAWATAN LUKA PERINIEM DENGAN LAMA WAKTU PENYEMBUHAN LUKA PERINIUM

2019 ◽  
Vol 7 (2) ◽  
pp. 67-73
Author(s):  
Annisa Ul Mutmainnah ◽  
Siti Noorbaya
Keyword(s):  
Wound Healing ◽  
Data Analysis ◽  
Random Sampling ◽  
Wound Care ◽  
Healing Time ◽  
Natural Process ◽  
Control Group ◽  
P Value ◽  
Research Subjects ◽  
Wound Area

Childbirth is a natural process, but sometimes labor can also cause birth canaltrauma, especially in the aluminum region, this trauma can be injuries to the periniumarea, the cause can be intentional biases such as episiotomy or unintentional actions such as spontaneous tears in the process of removing the baby. Injury to the perineum if not treated properly can cause postpartum infection because the wound area will be a medium for developing germs. The purpose of this study was to analyze the effect of the use of breast milk in the treatment of periniem wounds with the duration of perinium wound healing at the Ramlah Parjib Clinic in Samarinda. The method used in this study was Posttest Only Control Group Desigen research subjects were postpartum motherswith a sample of 60 respondents taken by random sampling and grouped based on treatment using ASI. Data analysis using ANOVA test. The results showed that the use of ASI had a significant effect on the treatment of periniem wounds with a healing time seen from the P value of 0,000. Conclusion: Periniuem wound care techniques are factors that influence the duration of perinieum wound healing

Functional Imaging in Wounds: Imaging Modalities of Today and Tomorrow

2021 ◽  
Author(s):  
Scott Stratman ◽  
Caralin Schneider ◽  
Hadar Lev-Tov ◽  
Robert Kirsner
Keyword(s):  
Wound Healing ◽  
Healthcare System ◽  
Wound Care ◽  
Significant Risk ◽  
Area Measurement ◽  
Imaging Modalities ◽  
Wound Area ◽  
Wound Assessment ◽  
Risk Of Mortality ◽  
The Us

Wound care is a multidisciplinary field with significant economic burden to our healthcare system. Not only does wound care cost the US healthcare system $20 billion annually, but wounds also remarkably impact the quality of life of patients; wounds pose significant risk of mortality, as the five-year mortality rate for diabetic foot ulcers (DFUs) and ischemic ulcers is notably higher compared to commonly encountered cancers such as breast and prostate. Although it is important to measure how wounds may or may not be improving over time, the only relative “marker” for this is wound area measurement—area measurements can help providers determine if a wound is on a healing or non-healing trajectory. Because wound area measurements are currently the only readily available “gold standard” for predicting healing outcomes, there is a pressing need to understand how other relative biomarkers may play a role in wound healing. Currently, wound care centers across the nation employ various techniques to obtain wound area measurements; length and width of a wound can be measured with a ruler, but this carries a high amount of inter- and intrapersonal error as well as uncertainty. Acetate tracings could be used to limit the amount of error but do not account for depth, thereby making them inaccurate. Here, we discuss current imaging modalities and how they can serve to accurately measure wound size and serve as useful adjuncts in wound assessment. Moreover, new imaging modalities are also discussed and how up-and-coming technologies can provide important information on “biomarkers” for wound healing.

scholarly journals On the Cutting Edge: Wound Care for the Endovascular Specialist

2018 ◽  
Vol 35 (05) ◽  
pp. 406-426
Author(s):  
Timothy Yates ◽  
Sofia Vianna ◽  
Omosalewa Adenikinju ◽  
Robert Beasley ◽  
Jon Houseworth ◽  
...  
Keyword(s):  
Wound Healing ◽  
Wound Care ◽  
Multidisciplinary Care ◽  
Limb Ischemia ◽  
Emerging Technology ◽  
Tissue Viability ◽  
Viability Assessment ◽  
Wound Debridement ◽  
Care Specialist ◽  
Hyperbaric Therapy

AbstractClinical outcomes in patients with critical limb ischemia (CLI) depend not only on endovascular restoration of macrovascular blood flow but also on aggressive periprocedural wound care. Education about this area of CLI therapy is essential not only to maximize the benefits of endovascular therapy but also to facilitate participation in the multidisciplinary care crucial to attaining limb salvage. In this article, we review the advances in wound care products and therapies that have granted the wound care specialist the ability to heal previously nonhealing wounds. We provide a primer on the basic science behind wound healing and the pathogenesis of ischemic wounds, familiarize the reader with methods of tissue viability assessment, and provide an overview of wound debridement techniques, dressings, hyperbaric therapy, and tissue offloading devices. Lastly, we explore emerging technology on the horizons of wound care.

Use of a bacterial fluorescence imaging device: wound measurement, bacterial detection and targeted debridement

2019 ◽  
Vol 28 (12) ◽  
pp. 824-834 ◽  
Author(s):  
Rose Raizman ◽  
Danielle Dunham ◽  
Liis Lindvere-Teene ◽  
Laura M Jones ◽  
Kim Tapang ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Fluorescence Imaging ◽  
Wound Care ◽  
Standard Of Care ◽  
Imaging Device ◽  
Wound Assessment ◽  
Coefficients Of Variation ◽  
Heavy Loads ◽  
Evidenced Based ◽  
Wound Bed Preparation

Objective: Diagnostics which provide objective information to facilitate evidence-based treatment decisions could improve the chance of wound healing. Accurate wound measurements, objective bacterial assessment, and the regular, consistent tracking of these parameters are important aspects of wound care. This study aimed to assess the accuracy, clinical incorporation and documentation capabilities of a handheld bacterial fluorescence imaging device (MolecuLight i:X). Method: Benchtop wound models with known dimensions and clinical wound images were repeatedly measured by trained clinicians to quantify accuracy and intra/inter-user coefficients of variation (COV) of the imaging device measurement software. In a clinical trial of 50 wounds, wound dimensions were digitally measured and fluorescence images were acquired to assess for the presence of bacteria at moderate-to-heavy loads. Finally, fluorescence imaging was implemented into the routine assessment of 22 routine diabetic foot ulcers (DFU) to determine appropriate debridement level and location based on bacterial fluorescence signals. Results: Wound measurement accuracy was >95% (COV <3%). In the clinical trial of 50 wounds, 72% of study wounds demonstrated positive bacterial fluorescence signals. Levine sampling of wounds was found to under-report bacterial loads relative to fluorescence-guided curettage samples. Furthermore, fluorescence documentation of bacterial presence and location(s) resulted in more aggressive, fluorescence-targeted debridement in 17/20 DFUs after standard of care debridement failed to eliminate bacterial fluorescence in 100% of DFU debridements. Conclusion: The bacterial fluorescence imaging device can be readily implemented for objective, evidenced-based wound assessment and documentation at the bedside. Bedside localisation of regions with moderate-to-heavy bacterial loads facilitated improved sampling, debridement targeting and improved wound bed preparation.

scholarly journals Routine Fluorescence Imaging to Detect Wound Bacteria Reduces Antibiotic Use and Antimicrobial Dressing Expenditure While Improving Healing Rates: Retrospective Analysis of 229 Foot Ulcers

Diagnostics ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. 927
Author(s):  
Nadine Price
Keyword(s):  
Wound Healing ◽  
Fluorescence Imaging ◽  
Point Of Care ◽  
Antibiotic Use ◽  
Foot Ulcers ◽  
Routine Practice ◽  
Bacterial Burden ◽  
Imaging Device ◽  
Antibiotics Use ◽  
Point Of Care Detection

Foot ulcers and their bacterial burden produce a significant strain on the National Healthcare System (NHS). Subjectivity of wound infection assessment makes appropriate dressing selection challenging. To aid point-of-care detection of bacterial burden, a fluorescence imaging device (MolecuLight i:X) was introduced to the Whipps Cross Hospital Podiatry clinic. This retrospective pre/post-analysis evaluated how implementation of fluorescence imaging impacted (1) antimicrobial dressings and antibiotics use and (2) wound healing rates. Over a 2-year period 229 lower extremity wounds were treated. Wound-related outcomes and antimicrobial dressing costs were quantified over 1-year before (2018/2019) and after (2019/2020) incorporating fluorescence imaging into routine practice. The period of fluorescence imaging saw a 27% increase in the number of wounds seen, yet annual antimicrobial dressing expenditure decreased by 33%. Implementation of fluorescence imaging was also associated with a 49% decrease in prescription of antimicrobial dressings, a 33% decrease in antibiotic prescriptions, and a 23% increase in wound healing rates within 12-weeks (48% vs. 39%), likely due to earlier bacterial detection and improved wound hygiene. This increased healing rate is projected to decrease annual wound costs by 10% (£762 per patient). Routine bacterial imaging appears to diminish clinical and economic burden to patients and the NHS.

scholarly journals The Effect of Adipose-Derived Stem Cells on Wound Healing: Comparison of Methods of Application

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Hyeonwoo Kim ◽  
Mi Ri Hyun ◽  
Sang Wha Kim
Keyword(s):  
Stem Cells ◽  
Wound Healing ◽  
Imaging System ◽  
Medical Problem ◽  
Adipose Derived Stem Cells ◽  
Control Groups ◽  
Impaired Wound Healing ◽  
Wound Area ◽  
Cell Based Therapy ◽  
Thickness Skin

Impaired wound healing is a significant medical problem. Recently, cell-based therapy focused on stem cells has been developed to overcome the challenges of defective wound healing. In this study, we aimed to evaluate the effectiveness of adipose-derived stem cells (ASCs) in promoting wound healing, using different techniques for administering them. Dorsal full-thickness skin defects (1×1 cm) were created in three groups of mice that received intravenous ASCs by intravenous injection, intramuscular injection, and topical application, respectively. Three control groups received saline in the same ways. Wound healing was assessed clinically, wounds were examined histologically, and GFP-labelled ASCs were detected with an IVIS imaging system. The results revealed that ASCs accelerated wound healing independent of their mode of administration. Histological examination showed that the ASCs accelerated reepithelialization, and IVIS analysis indicated that many ASCs were present in the wound area and disappeared after wound healing.

A novel debridement device for the treatment of hard-to-heal wounds: a prospective trial

2021 ◽  
Vol 30 (Sup5) ◽  
pp. S32-S36
Author(s):  
Omar Al-Jalodi ◽  
Laura M Serena ◽  
Kristy Breisinger ◽  
Keyur Patel ◽  
Khristina Harrell ◽  
...  
Keyword(s):  
Fluorescence Imaging ◽  
Wound Care ◽  
Bacterial Load ◽  
Prospective Trial ◽  
Comfort Level ◽  
Care Practice ◽  
Prospective Clinical Study ◽  
Bacterial Burden ◽  
Before And After ◽  
Direct Pressure

Objective: Debridement, the removal of nonviable tissue, forms the foundation of wound care practice. Clinicians have a variety of debridement methods at their disposal: sharp, biologic, enzymatic, autolytic and mechanical. The choice of debridement technique depends on the patient care setting, ulcer type and the clinician's experience, training, comfort level and licensure. This prospective study evaluated a novel debridement instrument, EZ-Debride (MDM Ventures, US). Cutting flutes on the head of the tool permit uniform removal of dead tissue while lessening the risk of deeper injury. It may also minimise pain during the debridement procedure. Method: Subjects with hard-to-heal wounds, drawn from a single wound care centre, participated in this institutional review board-approved prospective clinical study. Pain was measured before, during and after debridement using a numerical scale. Assessment of bacterial burden using fluorescence imaging (MolecuLight, Canada) was performed before and after debridement. Results: Enrolment of 10 male and 12 female subjects, with a total of 28 wounds, was carried out over a two-month period by two investigators at a single institution. The average age of subjects was 64 years (range: 22–95 years). The average wound duration was 29 weeks (range: 6–142 weeks). Wound types included diabetic foot, venous leg and pressure ulcers, post-surgical and traumatic wounds. The average pain score at the time of enrolment was 3.9. Subjects reported an average increase in pain with debridement of 0.6 points (range: 0–8). Fluorescence imaging demonstrated a reduction in bacterial load in 69% of cases, with complete resolution in 19% of wounds. Haemostasis was achieved with direct pressure in all cases and the only adverse event was a wound infection that occurred four days after debridement. Conclusion: The results suggest that this novel debridement tool can safely remove nonviable tissue with minimal discomfort and reduce bacterial burden similar to results achieved by sharp debridement.

Use of a flowable wound matrix to treat lower limb vascular ulcers

2021 ◽  
Vol 30 (11) ◽  
pp. 896-902
Author(s):  
Anna Florio ◽  
Marianna Sallustro
Keyword(s):  
Conflicts Of Interest ◽  
Wound Care ◽  
Graft Loss ◽  
Effective Rate ◽  
Healing Time ◽  
Leg Ulcers ◽  
Wound Area ◽  
Wound Matrix ◽  
Wound Bed Preparation ◽  
The University

Objectives: This study is aimed at assessing the safety and effectiveness of an advanced flowable wound matrix (FWM) in the treatment of hard-to-heal vascular leg ulcers that often involve deep structures, are irregular and/or tunnelled or excavated. Methods: Records of patients seen at our Vascular Surgery Unit, at the University of Campania ‘Luigi Vanvitelli’, for hard-to-heal vascular leg ulcers between January 2018 and January 2020 were retrospectively reviewed. For each wound aetiology, area and complications were recorded and evaluated. Every patient received one or more applications of FWM and was followed up. Results: A total of 22 patients (18 female/four male), mean age 63±8.5 years, were treated. The initial wound area ranged from 4–58cm2. After wound bed preparation, FWM was applied. Treatment was well tolerated and effective—rate of complications was low, graft take was very satisfactory, and no graft loss, rejection or superimposed infections were observed. Healing time was short: 85% of ulcers healed after 12 weeks. Most importantly, there was a decrease in the rate and level of amputations as compared with standard wound care. Conclusions: The data presented indicate that FWM is an option for the treatment of hard-to-heal vascular leg ulcers, particularly for those with an irregular cavity. Declaration of interest: The authors have no conflicts of interest.

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