Poster presented by Dr Stephan Landis, Department of Hospital Medicine, Ambulatory Wound Clinic, Guelph General Hospital (Guelph, Ontario)
CAWC Conference, Niagara Falls, November 3-6 2016.
BAF is a new bedside technique allowing visualization of planktonic bacterial groups within a chronic wound/periwound using a handheld device in real-time; “targeted” sharp debridement is feasible to optimize wound management.
To identify, using handheld BAF, subgroups of venous ulcers, which may be at increased risk of deep compartment infection post sharp debridement (D).
After obtaining consent, 41 patients with venous/lymphedema ulcers, followed through an ambulatory hospital and community clinic, were prospectively assessed pre- (Pre-D) and post-debridement (Post-D) using bedside white light visualization, and autofluorescent imaging to demonstrate the presence of planktonic bacterial groups in the wound. The wounds were stratified Pre-D and Post-D by the intensity of their BAF: 0 (none), +1 (light blush), +2 (bright, distinct), +3 (bright, confluent).
41 patients with 63 venous/lymphedema ulcers were identified (Nov 2015 – June 2016). 30/63 ulcers (48%) showed no Pre-D/Post-D BAF; 5/63 (8%) wounds with BAF pre-D showed no BAF post-D. However, nearly half 28/63 (44%) had evidence of BAF post-D with 6/63 (10%) showing more BAF post -D, 12/63 (19%) showing less, and almost a quarter 15/63 (24%) showing no change in BAF post-D.
In the real world of community care, sharp debridement even in expert hands, will not completely remove a wound bioburden; nearly half (44%) of our venous ulcers showed persistent or increased BAF Post-D. Our hypothesis is that venous ulcers with Post-D BAF or persistent measurable bioburden reflect that subgroup at increased risk of deep compartment infection. With these results in mind, a prospective cohort needs to be studied, using BAF imaging, mapped wound temperature and pain assessment to determine more selectively which patients with venous ulcers require more frequent debridement and/or systemic antibiotics.