Can Bacterial Fluorescence Predict Skin Graft Survival?

Bacterial fluorescence has high sensitivity and specificity in real-time to identify areas at high risk of skin graft lysis, according to a poster accepted at the Symposium on Advanced Wound Care (SAWC) Fall this week in Las Vegas.¹
 
As the authors note, autologous skin grafting is the gold standard for coverage of skin defects, although in patients who present wound infection, the graft failure rate is 3–4 times higher. The poster authors used bacterial fluorescence to evaluate wounds in 38 patients with burns before grafting. The fluorescence device identifies red, and cyan fluorescence, associated with regions of bacteria at loads of >10⁴ CFU/g. Researchers compared bacterial fluorescence-positive zones with graft loss zones.
 
As the poster says, 25 patients achieved 100% graft integrity. There were 0 total losses, 13 patients with partial loss, and 7 patients who required regrafting of lost graft area.
 
Comparing bacterial fluorescence versus culture (control) for gram bacteria, the authors noted sensitivity of 82% vs 44% and specificity of 100% vs 95% with a positive predictive value of 100% vs 88% and negative predictive value of 50% vs 21%.
 
Comparing bacterial fluorescence with graft loss, there was a sensitivity of 95%, specificity of 93%, a positive predictive value of 81%, and a negative predictive value of 98%.
 
Grafting areas where the fluorescence is negative offer >99% integration, conclude the authors. Grafting areas where the fluorescence is positive represent a high risk for loss.
 
Reference
 
1. Viana EH, Rojas Ortiz JA, Luna Zepeda BL. Bacterial Fluorescence an outcome prediction mechanism for skin graft survival. Poster accepted at the Symposium on Advanced Wound Care (SAWC) Fall.