Current and Future Directions in Fluorescence Imaging-Guided Debridement.

Significance: Sterility and reduction of the bioburden are crucial for healing in chronic wounds such as diabetic foot ulcers. Although there are methods for measuring bioburdens, such as semiquantitative analysis of swab/biopsy samples, microbiological sampling, and molecular diagnostics, these tools are less accessible owing to costs or not being as quick as other methods. These methods are also dependent on clinical assessment by the clinician, and high bacterial burden may appear asymptomatic. Recent Advances: Autofluorescence (AF) imaging is a novel technology for identifying and quantifying chronic inhibitory bacterial load in chronic wounds. Eighty-seven percent of bacteria that frequent chronic wounds have fluorophores that fluoresce under violet light as red or cyan, depending on the type of fluorophore. Therefore, AF image-guided treatment is becoming increasingly effective for physicians to implement wound dressing changes and debridement because bacterial burdens are difficult to locate clinically. Critical Issue: Products such as the commercially available MolecuLight i:X and MolecuLight DX function as handheld cameras for physicians to use as a reference but require additional work to ensure that the photograph will be taken with adequate lighting. Future Directions: Designs for Vision Inc. introduced a device called REVEAL, an AF imaging form factor that allows the device to be worn on top of a pair of glasses, which the physician would wear intraoperatively. The benefits of this form factor include not requiring certain lighting conditions and not having to interpret the results using a handheld camera, allowing the device to be used during active surgical debridement.