Absence of Bacterial Fluorescence Is Associated With Early Response to Skin Substitutes in Diabetic and Venous Ulcers: A Single-Blinded Prospective Study.

Cellular, acellular or matrix-like products (CAMPs), also referred to as 'skin substitutes', are applied to chronic wounds to help expedite healing when standard therapies fail. However, their efficacy is compromised by infection, and possibly high bacterial loads, as suggested in prior literature. This prospective observational pilot study explored the association between bacterial burden and early healing outcomes in chronic diabetic foot ulcers and venous leg ulcers following skin substitute application. Bacterial fluorescence imaging was performed immediately prior to skin substitute placement to identify areas of high bacterial load (positive fluorescence), with wound area reduction tracked at 4 ± 1 weeks postapplication. Of the 10 patients analysed, the primary endpoint of achieving 40% wound area reduction was met by 4/5 of baseline fluorescence negative wounds, compared to 0/5 baseline fluorescence positive wounds (p < 0.05). The baseline fluorescence negative group showed a 68.0% wound area reduction, in contrast to the baseline fluorescence positive group, which showed a 33.7% increase in wound area (p < 0.05). Taken together with existing evidence, these findings suggest that elevated bacterial load during CAMP application significantly impedes early wound healing. Bacterial fluorescence imaging is an effective tool to optimise wound bed preparation and identify the best candidate for skin substitute application.