Bacterial Fluorescence Signals Predict Dermal Regeneration Template Integration Outcomes

Acute trauma wounds with exposed bone or tendon present significant reconstructive challenges, with high rates of dermal regeneration template (DRT) failure, often due to missed infections. Standard-of-care wound assessment, which relies on subjective clinical signs and traditional swabbing methods, frequently fails to detect clinically significant bacterial loads (> 10⁴ CFU/g). This prospective observational study evaluated the ability of intraoperative bacterial fluorescence imaging to predict DRT outcomes in patients with complex wounds. A subset of 13 patients underwent a blinded fluorescence imaging procedure whereby modified Levine and fluorescence-guided cultures were collected immediately prior to DRT placement. We found a 63% overall DRT complication rate, with 56% of patients experiencing partial DRT failure despite being clinically and microbiologically cleared of infection pre-operatively. Fluorescence imaging demonstrated high predictive accuracy; DRTs placed on fluorescence-negative areas had an 85.6% success rate, whereas those placed on fluorescence-positive areas had a success rate of only 14.4%. Fluorescence-guided cultures detected pathogens more often than traditional methods. These findings suggest that fluorescence imaging shows potential value as an adjunctive tool for real-time, intraoperative bacterial detection, which can guide more effective wound bed preparation and significantly improve DRT integration rates.