The study evaluates the efficacy of fluorescence-guided de-colonization in patients with non-infected diabetic foot ulcers. The efficacy will also be compared between those who used artificial dermis and split-thickness skin graft for reconstruction surgery.
Diabetic foot ulcers (DFU) are the main cause of hospitalization in diabetic patients. These hard-to-heal ulcers have a high amputation rate, and a 5-year mortality rate of 50% once being amputated. Treatments for DFU include infection management, wound debridement, revascularization, pressure off-loading, etc. Recently, a novel imaging device called MolecuLight i:X was introduced to help visualize clinically undetectable fluorescent bacteria in wounds and has shown promising effects in the identification of infection. However, as microorganisms almost colonize all chronic wounds, the term "bacterial colonization" should be distinguished from clinical infection. While infection delays the healing process, the impact of colonization on wound reconstruction remains unclear; and the assessment is often more difficult on DFU patients with peripheral neuropathy and vascular diseases. In the present study, investigators will conduct a prospective randomized controlled trial to evaluate the clinical outcome of achieving "high-quality de-colonization" with the aid of MolecuLight i:X in the treatment of noninfected DFU patients, and to compare its efficacy between artificial dermis and split-thickness skin graft.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
210
MolecuLight is a handheld fluorescence imaging device that is utilized to help real-time visualize clinically undetectable fluorescent bacteria in wounds. It emits a 405 nm wavelength of safe violet light, which interacts with the wound tissue and bacteria causing certain bacteria to emit red or cyan fluorescence. The fluorescence signals were then captured by MolecuLight and those with bacteria at levels of ≥ 10\^4 colony forming units per gram (CFU/g) will be detected and displayed on the screen.
Shuang Ho Hospital First Medical Building
New Taipei City, Taiwan
Complete healing time
The time for complete wound epithelialization or closure without drainage after reconstruction surgery.
Time frame: 180 days after reconstruction surgery
Wound healing rate on 30, 60, 90 and 180 days
The healing percentage of wound 30, 60, 90 and 180 days after reconstruction surgery.
Time frame: 180 days after reconstruction surgery
Artificial dermis (AD) or split-thickness skin graft (STSG) take rate
The take percentage of artificial dermis or split-thickness skin graft 21 days after reconstruction surgery.
Time frame: 21 days after reconstruction surgery
Percentage of bacteria before MolecuLight de-colonization
The percentage of bacteria after the last debridement without using MolecuLight to do de-colonization.
Time frame: Immediately after last debridement
Percentage of bacteria after MolecuLight de-colonization
The percentage of bacteria after using MolecuLight to do de-colonization.
Time frame: Immediately after de-colonization with MolecuLight
Wound surface area on 30, 60, 90 and 180 days
The surface area of wound 30, 60, 90 and 180 days after reconstruction surgery.
Time frame: 30, 60, 90 and 180 days after reconstruction surgery
Reasons for poor AD or STSG take rate
Reasons for poor take rate of artificial dermis or split-thickness skin graft 21 days after reconstruction surgery may include as follows: (1) weak graft fixation (2) seroma (3) hematoma (4) wound localized infection (5) osteomyelitis (6) irreversible ischemic ulcers (7) systemic cause
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Time frame: 21 days after reconstruction surgery
Complications on 180 days
Complications evaluated 180 days after reconstruction surgery may include as follows: (1) wound recurrence (2) higher-level amputation (3) above or below knee amputation (4) vascular restenosis (5) mortality
Time frame: 180 days after reconstruction surgery
Vancouver scar score on 180 days
The vancouver scar score of wound evaluated 180 days after reconstruction surgery.
Time frame: 180 days after reconstruction surgery.