Steven Jeffery

Background: Biofilm-associated microbial burden is a major barrier to wound healing and is increasingly difficult to control in the era of antimicrobial resistance. This translational study evaluated the antimicrobial performance and tissue compatibility of a commercially available large-area cold atmospheric plasma (CAP) system (CPTpatch^®/CPTcube^®; Coldplasmatech GmbH, Greifswald, Germany) across in vitro, porcine, and clinical patient settings. Methods: CAP was tested against seven wound-relevant bacterial species, including multidrug-resistant strains, and the fungus Candida albicans in vitro, in two porcine MRSA-infected deep dermal wound models, and in a clinical service-evaluation cohort of 20 chronic lower-limb wounds in 14 patients; 17 wounds had evaluable longitudinal MolecuLight^® (Toronto, ON, Canada) fluorescence series. Results: In vitro, CAP induced rapid multi-log killing across the bacterial panel and showed a marked antifungal effect against C. albicans. In porcine MRSA wounds, CAP reduced bacterial burden versus sham by 1.65, 1.89, and 2.04 log10 CFU/g on Days 4, 8, and 11, equivalent to 97.8%, 98.7%, and 99.1% reductions. In a 72-h post-inoculation MRSA biofilm model, the strongest 5×/week regimen achieved 2.51 log10 (99.69%) and 3.18 log10 (99.93%) reductions versus baseline after 2- and 4-min CAP exposures, respectively. Clinically, twice-weekly CAP was associated with a significant decline in MolecuLight^® fluorescence grades over 5 weeks (p < 0.001); effective surface disinfection at 5 weeks was observed in 16/17 evaluable wounds. Conclusions: From bench to bedside, the investigated CAP system delivered rapid broad-spectrum antimicrobial activity, reduced MRSA burden in biofilm-infected porcine wounds, and was associated with clinically measurable suppression of wound surface bioburden while remaining tissue-sparing. These findings support further controlled studies to define clinical benefit in wound care.

Aims: To evaluate the clinical effectiveness of Epiprotect, a biosynthetic cellulose (BC) dressing, in promoting healing of chronic venous leg ulcers (VLUs). Methods: A study at two community wound care centres involved 20 patients who received 4 weeks of standard care, followed by 8 weeks of standard care plus the application of Epiprotect. Outcomes measured included percentage wound area reduction (PWAR), pain, exudate, adherence, and the number of Epiprotect sheets used. Healing was evaluated clinically and via photos, with feedback from staff and patients. Results: Epiprotect led to consistent and significant improvements. PWAR increased (p=0.046 and p=0.017). By the end, 11 participants had achieved over 75% healing, out of those 8 had achieved over 90%, and 3 had complete closure. Pain scores fell to zero by weeks 10–12 (p0.7, p<0.05). The average number of sheets used per patient was 2.20±1.05. Visual assessment showed better peri-ulcer skin and granulation tissue. Nursing staff found Epiprotect easy to apply and effective, while patients emphasised rapid pain relief and comfort. Conclusion: This evaluation shows that Epiprotect improves healing, reduces pain and exudate, and enhances adherence in chronic VLUs with minimal dressings. Patients and staff find it suitable for community care. Results support the need for larger trials comparing Epiprotect with standard care and other dressings.

Burns are complex injuries with devastating long-term impacts. Despite advancements in burn care, infections remain the leading cause of morbidity and mortality. Early and accurate detection of bacterial burden is critical for effective intervention, yet traditional diagnostic methods have limitations. Fluorescence imaging has emerged as an effective tool to enhance bacterial detection and guide infection management in burn wound management. This scoping review summarizes current evidence on fluorescence imaging-guided detection of bacterial loads in burn wounds and explores its potential role across different stages of burn care. A comprehensive literature search was conducted in PubMed using the inclusion and exclusion terms (“fluorescence” OR “autofluorescence”) AND (“burn” OR “burns”) AND “imaging” AND “bacteria” NOT “microscopy.” This search yielded 30 publications, which were further filtered to exclude preclinical studies, review articles, or articles that were not specific to burns. A total of 6 articles investigating the diagnostic accuracy of fluorescence imaging (MolecuLight) in patients with burn injuries were identified. This evidence suggests that fluorescence imaging improves the accuracy of bacterial detection in burns compared to clinical assessment alone, facilitating targeted wound sampling and debridement, enhancing antimicrobial stewardship, and guiding timely interventions. In addition, burn wound surgical planning may be optimized by fluorescence imaging-guided identification of areas requiring excision and grafting. Fluorescence imaging shows promise in enhancing bacterial detection in burn wounds, aiding clinical decision-making and infection management. However, further statistically powered studies are needed to evaluate its impact on patient with burn injury outcomes.

Burn wounds are complex injuries that require timely and accurate assessment to guide treatment decisions and improve healing outcomes. Traditional clinical evaluations are largely subjective, often leading to delays in intervention and increased risk of complications. Imaging technologies have emerged as valuable tools that enhance diagnostic accuracy and enable objective, real-time assessment of wound characteristics. This review aims to evaluate the range of imaging modalities currently applied in burn wound care and assess their clinical relevance, diagnostic accuracy, and cost-effectiveness. It explores how these technologies address key challenges in wound evaluation, particularly related to burn depth, perfusion status, bacterial burden, and healing potential. A comprehensive narrative review was conducted, drawing on peer-reviewed journal articles, NICE innovation briefings, and clinical trial data. The databases searched included PubMed, Ovid MEDLINE, and the Cochrane Library. Imaging modalities examined include Laser Doppler Imaging (LDI), Fluorescence Imaging (FI), Near-Infrared Spectroscopy (NIR), Hyperspectral Imaging, Spatial Frequency Domain Imaging (SFDI), and digital wound measurement systems. The clinical application and integration of these modalities in UK clinical practice were also explored. Each modality demonstrated unique clinical benefits. LDI was effective in assessing burn depth and perfusion, improving surgical planning, and reducing unnecessary procedures. FI, particularly the MolecuLight i:X device (MolecuLight Inc., Toronto, ON, Canada), accurately identified bacterial burden and guided targeted interventions. NIR and Hyperspectral Imaging provided insights into tissue oxygenation and viability, while SFDI enabled early detection of infection and vascular compromise. Digital measurement tools offered accurate, non-contact assessment and supported telemedicine use. NICE recognized both LDI and MolecuLight as valuable tools with the potential to improve outcomes and reduce healthcare costs. Imaging technologies significantly improve the precision and efficiency of burn wound care. Their ability to offer objective, non-invasive diagnostics enhances clinical decision-making. Future research should focus on broader validation and integration into clinical guidelines to ensure widespread adoption.

This report highlights the experiences of 2 individuals who suffered chemical burns leading to chronic dermatitis. Both patients were exposed to concentrated chemical cleaning agents that resulted in the development of persistent cutaneous conditions that worsened over time despite initial treatment and recovery. These cases evidence the long-lasting effects of chemical burns and highlight the importance of workplace safety measures and effective treatment strategies to prevent long-term complications. The report emphasizes the role of early medical attention, proper protective gear, and awareness of potential chemical sensitivities, in preventing and managing such injuries.

Understanding tissue loss following injury is important due to its prevalence among the war-wounded and the impact it has on subsequent treatment and rehabilitation. Progressive tissue loss is a type of tissue loss that has complicated extremity injury in recent conflicts. It has resulted in more proximal residual limb lengths and has influenced rehabilitation. Quantifying wound burden in combat casualties remains a challenge due to poor quality of data sets that lack the capacity for detailed analysis. The aims of this article are to outline the current hurdles in attempting to quantify wound burden in combat casualties and to propose simple interventions to improve data capture for future analysis.

Burn injuries constitute a critical economic burden on healthcare infrastructures worldwide. They are often associated with high mortality rates due to severe complications. Infection is the most common complication, highlighting the importance of prompt and precise diagnosis in order to prevent detrimental consequences and to optimize patient outcomes. Here we examine the current standard of care for diagnosing infection in both burn and chronic wounds followed by an investigation into the research surrounding a relatively new technique for bacterial detection, fluorescence imaging. With five years of published research on bacterial fluorescence imaging (MolecuLight i:X device), we have summarized and analysed the validity of the procedure and compared it to the current standard of care; clinical assessment and microbiological analysis. We highlight the benefits that could be obtained through the use of this technology as well as the limitations and the feasibility of incorporating this novel procedure into the standard of care.