Assessment of Tissue Viability in Complex Extremity Injuries: Utility of the Pyrophosphate Nuclear Scan

Abstract

Technetium-99 PyP scanning is a useful adjunct in predicting the need for amputation in extremities damaged by electrical injury, frostbite, or invasive infection. In addition, by providing an objective "picture" of extremity perfusion, PyP scans can be helpful in convincing patients of the need for amputation.

One Hundred Ninety-Five Cases of High-Voltage Electric Injury

“…13 Technetium-99 pyrophosphate, which shows increased uptake in areas in which approximately 20% to 60% necrosis has occurred and which shows no uptake in completely necrotic limbs, has been used by several centers to plan operative intervention. 15, 16 Lee et al 12 have recommended the use of magnetic resonance imaging as soon as possible after patient arrival to identify edematous muscle compartments. This information is used to guide compartment pressure measurements.…”

Practice Guidelines for the Management of Electrical Injuries

“…40,41 Other studies have questioned the utility of nuclear scans in this setting. They have fallen out of favor in routine cases, 42 although some centers reported use of this modality selectively.…”

Decreased Radiopharmaceutical Uptake (Photopenia) in Delayed Phase Scintigraphic Images in Three Horses

“…Scintigraphy is commonly used in people to assess tissue viability in soft tissues and findings of areas of infarction and nonviability in cardiac tissue are common 16 . Scintigraphy has proven value as an aid in determining tissue viability in people with complex injuries of the extremities 16–19 . In people with electrical burns and frostbite, photopenia is an accurate way to predict tissue necrosis and lack of viability 16–19 .…”