A precision-based approach for bioactive skin allograft application in nonhealing wounds using bacterial fluorescence
Jack L Knott1, Kathy K Wang1, Daniel P deLahunta1
1Section of Wound Healing and Tissue Repair, Department of Surgery, University of Illinois College of Medicine, Chicago, IL, USA.
Background:
Chronic wounds present significant clinical challenges and often require advanced modalities such as cellular and/or tissue-based products (CTPs), also referred to as cellular, acellular, and matrix-like products. Bioactive skin allograft (BSA) is a type of CTP composed of living fibroblasts, keratinocytes, cytokines, and collagen that is widely used for nonhealing wounds. Before applying a BSA, standard of care involves lowering the bioburden through wound bed preparation; however, classic methods to assess bioburden can be unreliable. Bacterial fluorescence imaging (FL-imaging) is a recent technology that allows for the detection of clinically significant bioburden using a noninvasive, point-of-care device. Few studies have applied FL-imaging directly to BSA management.
Objective:
To evaluate the use of FL-imaging to direct and manage the use of BSAs before, during, and after their application.
Materials And Methods:
BSAs were applied after ensuring adequate tissue perfusion, 30 days of local wound care, and medical optimization. Debridement was performed and adequacy verified using FL-imaging before BSA placement. FL-imaging was used to monitor graft sites at day 3, 7, and 14 after initial application.
Results:
Although FL-imaging confirmed initial debridement success, subsequent scans revealed bioburden recurrence that compromised BSA viability in several cases. These findings informed the development of a preliminary protocol using FL-imaging to confirm adequate debridement and guide postoperative graft monitoring and salvage.
Conclusion:
The systematic adoption of FL-imaging could provide a consistent method for wound bed preparation and graft monitoring in the future, while encouraging clinicians to use BSAs with a cost-efficient, consistent, and evidence-based approach.
