Plastic and Reconstructive Surgery Department, Mexico City General Hospital Dr. Rúben Leñero, Mexico.
Plastic and Reconstructive Surgery Department, Mexico City General Hospital Dr. Rúben Leñero, Mexico.
Burns. 2024 Sep;50(7):1799-1811. doi: 10.1016/j.burns.2024.04.003. Epub 2024 Apr 15.
Split-thickness skin graft (STSG) integration rates are susceptible to improvement. Infection and/or biofilm should be appropriately addressed prior to grafting to improve the likelihood of graft-take. Incorporating technological aids such as fluorescence (FL) imaging (MolecuLight®), which accurately locates areas of bacterial loads above 10 CFU/gr, for graft site assessment and preparation could yield better outcomes.
This single-center, prospective observational study included adult burn patients with previously infected wounds that had been deemed clinically and microbiologically clean and were therefore candidates for grafting. Prior to grafting, a FL imaging assessment (blinded to the surgical team) localized areas positive for moderate-high bacterial loads (>10 CFU/gr). Intra-operatively, a standard swab sample from the recipient site was collected by the surgical team. Postoperatively, areas positive/negative for FL and areas of graft take and failure were overlapped and measured (cm) over a 2D schematic. The performance and accuracy of FL imaging and swab sampling in relation to graft outcomes were assessed.
38 patients were enrolled in the study. The mean total body surface area (TBSA) involvement was 14.5 ± 12.4 % [range 0.8 - 40.2 %]. 25/38 of the subjects enrolled had complete graft take while 13 had partial graft losses. There were no total losses. FL-imaging was positive in 100 % of losses versus 31 % (4/13) of the swab microbiology. FL-imaging was found to have a sensitivity of 86 %, specificity of 98 %, PPV of 72 %, NPV of 99 %, and an accuracy of 94 % for predicting any type or range of graft loss in the entire cohort. Meanwhile, the sensitivity of microbiology from swab samples was 30 %, with a specificity of 76 %.
FL imaging is an accurate method for assessing recipient sites and predicting the outcome of a skin graft among burn patients. These findings suggest that FL imaging can inform better decision-making surrounding grafts that may lead to better outcomes.
Level IIA, Therapeutic study.
游离皮片（STSG）的成活率容易提高。在移植前应适当处理感染和/或生物膜，以提高皮片成活率。采用荧光（FL）成像（MolecuLight®）等技术辅助手段，准确定位细菌负荷超过 10 CFU/gr 的区域，进行供皮区评估和准备，可能会获得更好的效果。
本单中心前瞻性观察研究纳入了先前感染的成年烧伤患者，这些患者的创面已被认为是临床和微生物学上清洁的，因此适合进行移植。在移植前，FL 成像评估（对手术团队进行盲法）定位中度至高度细菌负荷（>10 CFU/gr）的阳性区域。术中，由手术团队采集供皮区的标准拭子样本。术后，将 FL 阳性/阴性区域和皮片成活/失败区域重叠，并在 2D 示意图上进行测量（cm）。评估 FL 成像和拭子采样与皮片成活率的关系。
研究共纳入 38 例患者。平均总体表面积（TBSA）受累面积为 14.5±12.4%（范围 0.8-40.2%）。25/38 例患者的皮片完全成活，13 例患者的皮片部分丢失，无完全丢失。FL 成像在所有丢失病例中均为阳性（100%），而在拭子微生物学中仅为 31%（13/13）。FL 成像对整个队列中任何类型或范围的皮片丢失的预测具有 86%的灵敏度、98%的特异性、72%的阳性预测值、99%的阴性预测值和 94%的准确性。同时，拭子样本微生物学的灵敏度为 30%，特异性为 76%。
FL 成像可准确评估供皮区并预测烧伤患者皮片成活率。这些发现表明，FL 成像可更好地指导皮片移植决策，从而获得更好的结果。
IIA 级，治疗性研究。
