Diagnosis and Treatment of the Invasive Extension of Bacteria (Cellulitis) from Chronic Wounds Utilizing Point-of-Care Fluorescence Imaging

In this interview, Ms Weir talks with Dr Andersen regarding a poster (Diagnosis and Treatment of the Invasive Extension of Bacteria [Cellulitis] from Chronic Wounds Utilizing Point-of-Care Fluorescence Imaging) presented at the Symposium on Advanced Wound Care Fall (SAWC). Data from this poster were presented at the SAWC Fall in Las Vegas, Nevada (October 29-31, 2021).

This video was sponsored by MolecuLight.

Transcript

Dot Weir: Hello. My name is Dot Weir. I'm a wound clinician, a wound nurse from Saratoga Hospital's Center for Wound Healing and Hyperbaric Medicine in Saratoga Springs. Chuck.

Dr Charles Andersen: I'm Chuck Anderson. I'm a vascular surgeon by trade. I work at Madigan Army Medical Center. Involved in a limb preservation initiative. Currently, I'm chief of the Wound Care Service at Madigan Army Medical Center.

Ms Weir: I'm really happy to be talking to you today. We've just gotten our MolecuLight imaging device and are still in the honeymoon period where we're using it mostly to target our cleansing, target our debridement, look at the area. I'm very anxious to hear—because I saw your poster, I saw your paper—how you arrived at the data that you did.

Dr Andersen: Thank you. Actually, we're very excited about that. We've used the MolecuLight now for about 2 years. We've scanned a lot of different patients. This current paper looks at 236 patients over an 18-month period of time.

What we found in those 236 patients was that 15 of those patients had a different pattern to the fluorescence. I highly respect your emphasis on wound cleansing. We try to follow that.

The algorithm that we use is that when we see fluorescence, then we attempt to remove that fluorescence by debriding the wound, by actively cleansing the wound. What we found, Dot, is in, as I mentioned, a small subset, 6.5%.

A small subset of patients, despite debridement, and despite active cleansing, the fluorescence persists. It persists in a rather unique pattern. Almost like a fan shaped extension, going out into the subcutaneous tissue. That's what we refer to wound-related cellulitis.

Ms Weir: Have you found that as you've done the targeted cleaning, you've done the debridement, you've done the cleansing, that sometimes you're exposing more of the red or scarlet color? Have you seen that?

Dr Andersen: We have, indeed. Interestingly enough, mainly in pressure ulcers that oftentimes there's a lot of slough. There's a lot of scaly, dry skin. When you look at that, you'd have a very low threshold for considering even colonization, let alone cellulitis.

When you debride all of that, what we've found is first of all, about 85% of our patients with pressure injuries have fluorescence. That was striking to us. In a subset, what we see is very persistent fluorescence, indicating cellulitis.

The reason we're excited is if that early cellulitis goes untreated, then there's that potential that it will become a very serious infection. I was very interested in the presentation today on pressure injuries, where they quoted a statistic that 1600 patients a year die from sepsis related to pressure ulcers.

If we can identify that early extinction of bacteria, aggressively clean the wound, cleanse the wound, and when indicated, put on a short course of oral antibiotics, then you can clear that bacteria. Then you don't have to admit those patients. They don't go on to become septic. You're being very, very proactive in identifying the cellulitis, and proactive in treating it.

Ms Weir: Sure. Your paper and your poster have great pictures. Great examples of this extension, I will say, if I'm saying that right, of the color that shows the bacteria there. Not just focused right around the wound. Is there a distance out that you looked for?

Dr Andersen: It's a fan-like extension. What we do not call cellulitis is if there's a ring of fluorescence around a callus. That's not uncommon. We do not call that cellulitis. It's when we've done the thorough cleansing that you talk about, and you still see that extension going out into the surrounding tissue. Many times, it extends a fair distance.

Ms Weir: I could tell that on your pictures. The periwound is so important, because we have found a lot of the fluorescence in maceration. Not just callus, but maceration.

Dr Andersen: Yes.

Ms Weir: That's very interesting. I'm going to share that paper with a lot of people. [laughs]

Dr Andersen: Thank you. Thank you very much.