Is Your Wound Bioburdened? Case 3

CASE AND INITIAL EXAMINATION

• A 77-year-old, non-smoking female with diabetes came into the clinic for a postoperative assessment.

• The patient presented with a non-healing surgical wound resulting from a great toe amputation 3 weeks prior. Click here for photo.

• She had poor vascularity, normal blood sugar levels, and there were no signs or symptoms of infection (no malodor, purulent drainage, or cellulitis). Click here for photo.
 
 

CLINICAL DECISION

• Fluorescence imaging (MolecuLight i:X) revealed bright red and blush fluorescence in the wound bed and periwound, respectively, indicating pathogenic bacterial burden at levels of >10⁴ CFU/g. Click here for photo.

• A sample from the area of bright red fluorescence was cultured and later came back positive for Corynebacterium, Enterococcus, and Peptostreptococcus. Click here for photo.

The wound was treated with antimicrobial dressings (Aquacel Ag Advantage, ConvaTec Inc.) and the patient returned two and three weeks later for treatment using a novel molecular debridement technology (Epien Medical Inc.). Click here for photo.
 
 

OUTCOME

• One month after initial MolecuLight imaging, follow-up scans showed significantly less red fluorescence (indicating reduced bacterial load) and therapy continued with the application of silver-impregnated collagen dressings. Click here for photo.

• The wound continued to improve and went on to heal completely. Negative fluorescence imaging scans confirmed the absence of elevated bacterial burden. The patient avoided further amputation from an infected surgical wound, and her limb was preserved. Click here for photo.

• Using fluorescence imaging information, serious postoperative complications were avoided, which have the potential to be devastating in a diabetic patient with poor vascularity.
 
Raymond Abdo, DPM, practices at St. Louis Foot & Ankle in St. Louis, MO.

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