Using Bacterial Autofluorescence Pre and Post Ultrasound Debridement
Dr. Tyler Sexton, MD, MAPWCA
Case details
A patient presented to the Brevard Regional Hyperbaric Center for Wound Care Consultation. The patient sustained leg trauma which required surgical intervention. The postoperative course was complicated by wound infection with subsequent wound dehiscence. Initial wound center evaluation showed wound dehiscence with retained bridging sutures. The wound base revealed the presence of thick adherent slough with non-viable fibrinous debris. While the tissues showed no frank infection or cellulitis, the clinical impression of suggested significant bacterial colonization and biofilm. The decision was made to perform wound debridement using ultrasonic technology (AR 1000, Arobella Medical, Minneapolis, MN). Prior to debridement the wound was imaged using bacterial autofluorescence (SnapshotGLO, Kent Imaging, Calgary, Canada).
The wound contained a few remaining non-functional sutures that were bridging the wound. The wound base shows heavy fibrin and slough. The peri wound erythema is consistent with inflammatory changes, without cellulitis. SnapshotGLO imaging confirmed the clinical impression of significant wound bacteria.
Image 1. SnapshotGLO images. Pre-debridement wound with dehiscence and sutures in place images. Left: clinical image. Right: bacterial autofluorescence image.
Treatment planning with snapshotglo
All sutures were removed, and the wound was then sharply debrided using ultrasonic curettage. Post-debridement imaging found near complete removal of all nonviable tissue which correlates with the bacterial autofluorescence. SnapshotGLO imaging indicated a dramatic bioburden reduction, confirming the clinical impression of a successful debridement.
Image 2. SnapshotGLO images, left: clinical, right: bacterial autofluorescence. Post US debridement with sutures removed.
case outcomes
The presence of non-functional suture material in compromised wounds presenting to wound care specialists is not uncommon. When these sutures have no remaining surgical purpose, such as maintaining surgical incision integrity or enhancing reduction of deep space, they are simply foreign bodies and often serve to contribute to wound inflammation and compromised healing. As demonstrated in this case these, non-functional sutures must be removed. A collaborative relationship founded on excellent communication with the referring surgeon allows appropriate and thorough wound bed debridement enhancing care.
This case clearly shows that wound debridement complimented and guided by bacterial autofluorescence imaging using SnapshotGLO decreases wound bioburden and enhances debridement outcomes.
“SnapshotGLO allows you to do an adequate debridement. Removing bacteria is the key to good wound bed preparation.”
Thank you to Dr Sexton and his clinical team for this case study.
Dr. Tyler Sexton is the Chief Medical Officer (CMO) at Brevard Regional Hyperbaric Center Melbourne Florida; CMO, UrgentFlex Orlando Fl; CMO, TrueHyperbarRx , Orlando, Fl; CMO, Coastal Hyperbarx Ocean Springs, MS; and CMO, Precision Hyperbarics, Tampa, Fl.