(CS-006) Advanced Wound Care of Pyoderma Gangrenosum Through Fluorescence-Guided Debridement

Katherine McLeod, RN – Madigan Army Medical Center; Alisha Oropallo, MD FACS, FSVS, FAPWCA, FABWMS – Northwell Health; Amit Rao, Project manager – Northwell Health

Introduction: Pyoderma gangrenosum (PG) is an ulcerative cutaneous condition linked to autoimmune disease that shows pathergy in 30% of patients. Trauma worsens PG lesions, and targeted fluorescence*-guided debridement, with 8-fold superior sensitivity in bedside detection of bacterial burden compared to clinical assessment alone, may improve outcomes by limiting surgical trauma to the minimum necessary.

Methods: This multi-site case series of 8 patients demonstrates the benefits of conservative, precisely targeted debridement of PG lesions guided by fluorescence imaging of bacteria*. This is a bedside, handheld non-invasive device, making it an ideal tool to aid in the assessment and treatment of PG.

Results:

A cohort of eight patients underwent rigorous monitoring, with an average frequency of once per week, across two specialized wound care clinics in New York and Washington state. Initial assessments revealed bacterial fluorescence (FL) positivity in all patients, even though not all exhibited overt clinical signs of infection. By implementing a comprehensive strategy encompassing targeted debridement and various topical interventions, substantial progress was observed in all cases. This was evidenced by the noteworthy reduction in wound area and the conspicuous absence of fluorescence in each instance.

Discussion:

Utilizing a fluorescence imaging device to visualize the location of pathogenic bacterial loads and biofilm enabled precise and conservative debridement of bacteria-laden tissues—a crucial step in initiating the healing cascade according to TIME management principles. All patients exhibited wound area reduction or complete healing, showcasing the effectiveness of this conservative approach in mitigating the onset of the pathergy phenomenon associated with PG. While the literature reports improved outcomes owing to the influence of fluorescence imaging on treatment selection, including debridement guidance in other wound types, this case series represents the first focused examination of PG exclusively. Fluorescence imaging is a valuable and uniquely suitable bedside tool for the enablement of conservative, minimally traumatizing debridement. This type of debridement applies to PG, and many other patient conditions where tissue removal must be conservative.