Acute trauma wounds with exposed bone or tendon present significant reconstructive challenges, with high rates of dermal regeneration template (DRT) failure, often due to missed infections. Standard-of-care wound assessment, which relies on subjective clinical signs and traditional swabbing methods, frequently fails to detect clinically significant bacterial loads (> 104 CFU/g). This prospective observational study evaluated the ability of intraoperative bacterial fluorescence imaging to predict DRT outcomes in patients with complex wounds. A subset of 13 patients underwent a blinded fluorescence imaging procedure whereby modified Levine and fluorescence-guided cultures were collected immediately prior to DRT placement. We found a 63% overall DRT complication rate, with 56% of patients experiencing partial DRT failure despite being clinically and microbiologically cleared of infection pre-operatively. Fluorescence imaging demonstrated high predictive accuracy; DRTs placed on fluorescence-negative areas had an 85.6% success rate, whereas those placed on fluorescence-positive areas had a success rate of only 14.4%. Fluorescence-guided cultures detected pathogens more often than traditional methods. These findings suggest that fluorescence imaging shows potential value as an adjunctive tool for real-time, intraoperative bacterial detection, which can guide more effective wound bed preparation and significantly improve DRT integration rates.
García et al. (Sun,) studied this question.