Burn Depth Estimation Using Indocyanine Green Fluorescence

Abstract

Expedient primary excision of deep dermal and full-thickness burn wounds with subsequent skin grafting is the standard of care in most burn institutions, but differentiating full-thickness from partial-thickness burns is often difficult. Because accurate early assessment of burn depth may improve care, a variety of technical methods have attempted to measure burn depth but these methods have had limited success. We describe a new technique to determine burn depth that uses infrared (840- to 850-nm) fluorescence emission from intravenously administered indocyanine green following excitation with infrared (780 nm) and UV light (369 nm). Full-thickness and partial-thickness burns in hairless rat skin were distinguished based on the infrared-induced and UV-induced fluorescence intensity ratios relative to normal, unburned skin immediately after the burn and on post-burn days 1 through 3 and 7. Dual-wavelength excitation of indocyanine green infrared fluorescence can delineate full-thickness from partial-thickness burns at an early date, allowing prognosis, surgical planning, and early primary excision and grafting.

Indocyanine Green Fluorescence Measurement of Intestinal Transit and Gut Perfusion after Intestinal Manipulation

“…Most of the described systems have the major disadvantage that they are not easy to use in the human intraoperative situation. The IC-VIEW system is used in various conditions, intra-and postoperatively, to measure blood perfusion and microcirculation [29][30][31][32]. It has been proven effective and reliable in the settings of intraoperative assessment of vascular flow, evaluation of abdominal wall perfusion and intraoperative measurement of skin-flap viability [33,34].…”

Assessment of burn depth and burn wound healing potential

“…Indocyanine green (ICG) is a harmless dye that is administered intravenously and then 5-10 min later the skin is irradiated with light at one wavelength while the fluorescence is observed at another wavelength. Presence and strength of the fluorescence indicate presence and strength of blood flow, expressed as a ratio to normal skin [38]. Recent modification of this technique using videography instead of angiography allows the capturing of dynamic changes in tissue perfusion [39].…”

Quantitative Optical Spectroscopy for Tissue Diagnosis

“…Upon i.v. administration, the dye is tightly bound to serum albumin and partitioned in the vascular space, except in diseases whereby vascular integrity is compromised, such as in the case for burn victims (206) or as a result of tumor angiogenesis (207).…”