Abstract:

As the prevalence of chronic wounds continues to rise, the need for point of care wound assessment has also increased. While a variety of technologies have been developed to improve diagnostic abilities and monitoring of wounds, none have proven completely effective in all settings. Further, many of the stalwart wound management techniques remain costly, time consuming, and technically challenging. The two key pivotal events of ischemia and infection can lead to limb loss. A relatively new crop of fluorescence-based technologies, including devices that measure pathogenic auto-fluorescence, fluorescence angiography, or map cutaneous oxygenation, are increasingly being utilized for adjunct wound assessment—both clinical and operative settings can address these events. These technologies offer rapid, efficient, visual, and quantitative data that can aid the wound provider in evaluating the viability of tissues, ensuring adequate perfusion, and optimizing wound bed preparation. In the following review, pathogenic auto-fluorescence is compared to gross evaluation of wound infection and culture based diagnostics, indocyanine green fluorescence angiography is compared to various methods of visual and physical assessments of tissue perfusion by the practitioner, and cutaneous oxygenation is compared to clinical signs of ischemia. We focus on the current applications of fluorescence technologies in wound management, with emphasis placed on the evidence for clinical and operative implementation, a safety analyses, procedural limitations, and the future direction of this growing field of wound assessment.

Authors:

Daniel E. Wainstein, MD, Staff Surgeon, Pirovano Hospital, Buenos Aires, Argentina, Pablo Sisco, MD, Chief Surgeon, Pirovano Hospital, Buenos Aires, Argentina, María L. Deforel, MD, Medical Staff, Pirovano Hospital, Buenos Aires, Argentina, Mariano Irigoyen, MD, Staff Surgeon, British Hospital, Buenos Aires, Argentina, Jorge Devoto, MD, Concurrent, Pirovano Hospital, Buenos Aires, Argentina, Juan M. Zarate, Resident, Pirovano Hospital, Buenos Aires, Argentina

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