Fluorescence imaging in surgical wound management: A consensus-based approach
DOI:
https://doi.org/10.63676/pxws0177Abstract
The rapid evolution of imaging technologies has transformed our approach to managing surgical wounds. Among these innovations, fluorescence imaging stands out as a tool with profound implications for clinical practice, patient outcomes, and healthcare systems at large. The integration of point-of-care fluorescence imaging can reshape clinical workflows by providing objective, real-time insight into bacterial burden.
This manuscript represents a consensus-driven, multidisciplinary effort to capture the clinical utility, procedural integration, and emerging standards surrounding the use of fluorescence imaging throughout the surgical care continuum. From pre-operative assessment to intra-operative precision and post-operative surveillance, the chapters that follow illustrate how this technology is helping to close the diagnostic gap that has historically hindered timely and appropriate interventions for bacterial burden.
In an era marked by increasing antimicrobial resistance, patient complexity, and medicolegal scrutiny, the ability to visualize pathogenic threats before they manifest as clinical complications is no longer a luxury but a necessity. It is my hope that this manuscript will serve as both a guide and a catalyst for further adoption, investigation, and refinement of fluorescence imaging in surgical practice. The evidence and opinions expressed here are compelling. Fluorescence imaging has the potential to improve outcomes in surgical patients across the globe.
References
1. Sandy-Hodgetts K, Carville K, Leslie GD. Determining risk factors for surgical wound dehiscence: a literature review. Int Wound J. 2015;12(3):265-275. https://doi.org/10.1111/iwj.12088
2. Armstrong DG, Edmonds ME, Serena TE. Point-of-care fluorescence imaging reveals extent of bacterial load in diabetic foot ulcers. Int Wound J. 2023;20(2):554-566. https://doi.org/10.1111/iwj.14080
3. ISWCAP. International consensus: surgical wound complications prevention. Wounds Int. 2022. https://woundsinternational.com/wp-content/uploads/2023/02/933dfca2e2e9ea57418b7fe1e165d9e0.pdf (accessed 14 August 2025)
4. Wounds International. International Consensus Update 2022 International Wound Infection Institute (IWII) Wound Infection in Clinical Practice: Principles of best practice. https://woundsinternational.com/consensus-documents/wound-infection-in-clinical-practice-principles-of-best-practice/ (accessed 14 August 2025)
5. Le L, Baer M, Briggs P, et al. Diagnostic Accuracy of Point-of-Care Fluorescence Imaging for the Detection of Bacterial Burden in Wounds: Results from the 350-Patient Fluorescence Imaging Assessment and Guidance Trial. Adv Wound Care. 2021;10(3):123-136. https://doi.org/10.1089/wound.2020.127
6. Sandy-Hodgetts K, Andersen CA, Al-Jalodi O, Serena L, Teimouri C, Serena TE. Uncovering the high prevalence of bacterial burden in surgical site wounds with point-of-care fluorescence imaging. Int Wound J. 2022;19(6):1438-1448. https://doi.org/10.1111/iwj.13737
7. Li TH, Lin CH, Peng CK et al. Effects of adjuvant hyperbaric oxygen therapy and real-time fluorescent imaging on deep sternal wound infection: a retrospective study. J Wound Care. 2025;34(1):48-58. https://doi.org/10.12968/jowc.2022.0095
8. Price N. Routine fluorescence imaging to detect wound bacteria reduces antibiotic use and antimicrobial dressing expenditure while improving healing rates: retrospective analysis of 229 foot ulcers. Diagnostics (Basel). 2020;10(11):927. https://doi.org/10.3390/diagnostics10110927
9. Kelso MR, Jaros M. Improving wound healing and infection control in long-term care with bacterial fluorescence imaging. Adv Skin Wound Care. 2024;37(9):471-479. https://doi.org/10.1097/ASW.0000000000000177
10. Hsu JC, Chu YH, Wu YC et al. Application of perioperative real-time fluorescence imaging to achieve high-quality debridement: a randomized control trial. Adv Wound Care (New Rochelle). 2025. https://doi.org/10.1177/21621918251359558
11. Jeffery S. The utility of MolecuLight bacterial sensing in the management of burns and traumatic wounds. Proceedings Volume 10863, Photonic Diagnosis and Treatment of Infections and Inflammatory Diseases II. 2019. https://doi.org/10.1117/12.2504377
12. Adanna Okeahialam N, Thakar R, Sultan AH. The clinical progression and wound healing rate of dehisced perineal tears healing by secondary intention: A prospective observational study. Eur J Obstet Gynecol Reprod Biol. 2022;274:191-196. https://doi.org/10.1016/j.ejogrb.2022.05.035
13. Li T-H, Lin C-H, Peng C-K et al. Effects of adjuvant hyperbaric oxygen therapy and real-time fluorescent imaging on deep sternal wound infection: a retrospective study. J Wound Care. 2025; 2;34(1):48-58. https://doi.org/10.12968/jowc.2022.0095
14. Serena TE. Incorporating point-of-care bacterial fluorescence into a wound clinic antimicrobial stewardship program. Diagnostics (Basel). 2020;10(12):1010. https://doi.org/10.3390/diagnostics101210100
15. Trafelet N, Johnson S, Schroder J, Serena TE. Audit of antimicrobial prescribing trends in 1447 outpatient wound assessments: baseline rates and impact of bacterial fluorescence imaging. Diagnostics (Basel). 2024;14(18):2034. https://doi.org/10.3390/diagnostics14182034
16. Chen CH, Lee YC, Wu YC et al. Multidisciplinary strategies with real-time fluorescence images and negative pressure wound therapy to manage organ/space surgical site infection in transplanted kidneys. Ann Plast Surg. 2023;90(1 Suppl 1):S60-S67. https://doi.org/10.1097/SAP.0000000000003379
17. Okeahialam NA, Thakar R, Sultan AH. Bacterial autofluorescence in infected perineal wounds: A prospective cohort study. Diagn Microbiol Infect Dis. 2023;105(1):115831. https://doi.org/10.1016/j.diagmicrobio.2022.115831
Published
Issue
Section
License
Copyright (c) 2025 International Journal of Tissue Repair
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
