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].…”

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].…”

Utility of Indocyanine Green Fluorescence Imaging in Wound Assessment

“…Historically, the first use of ICG fluorescence imaging for wound assessment was to estimate burn depth in an animal study [9]. It was then applied to human burn depth estimation in 1995 [10].…”

An Inconvenient Truth of Clinical Assessment and Indocyanine Green Angiography Precise Marking for Indeterminate Burn Excision

“…Thirty-three percent of maximal perfusion was used as the cut-off point between superficial and deep seconddegree burns. 5,9,[14][15][16][17][18][19] The cut-off point was derived from the previous diagnostic study using ICGA in indeterminate burn and reported to provide high accuracy. 5 Superficial second-degree burns were defined as burns with maximal perfusion of more than 33%, deep second degree burns were defined as burns with maximal perfusion of <33%.…”

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].…”

Utility of Indocyanine Green Fluorescence Imaging in Wound Assessment

“…Historically, the first use of ICG fluorescence imaging for wound assessment was to estimate burn depth in an animal study [9]. It was then applied to human burn depth estimation in 1995 [10].…”

An Inconvenient Truth of Clinical Assessment and Indocyanine Green Angiography Precise Marking for Indeterminate Burn Excision

“…Thirty-three percent of maximal perfusion was used as the cut-off point between superficial and deep seconddegree burns. 5,9,[14][15][16][17][18][19] The cut-off point was derived from the previous diagnostic study using ICGA in indeterminate burn and reported to provide high accuracy. 5 Superficial second-degree burns were defined as burns with maximal perfusion of more than 33%, deep second degree burns were defined as burns with maximal perfusion of <33%.…”

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].…”

Utility of Indocyanine Green Fluorescence Imaging in Wound Assessment

“…Historically, the first use of ICG fluorescence imaging for wound assessment was to estimate burn depth in an animal study [9]. It was then applied to human burn depth estimation in 1995 [10].…”

An Inconvenient Truth of Clinical Assessment and Indocyanine Green Angiography Precise Marking for Indeterminate Burn Excision

“…Thirty-three percent of maximal perfusion was used as the cut-off point between superficial and deep seconddegree burns. 5,9,[14][15][16][17][18][19] The cut-off point was derived from the previous diagnostic study using ICGA in indeterminate burn and reported to provide high accuracy. 5 Superficial second-degree burns were defined as burns with maximal perfusion of more than 33%, deep second degree burns were defined as burns with maximal perfusion of <33%.…”