Fluorescence angiography-assisted debridement of critically perfused glabrous skin in degloving foot injuries

Abstract

Rationale: Degloving foot injuries are challenging to treat and associated with life-long sequelae for patients. An appropriate debridement of ischemic soft tissues with maximal preservation of glabrous skin is key during the reconstruction of these injuries. Indocyanine green (ICG) fluorescence angiography is an established technique for the intraoperative evaluation of tissue perfusion. Patient concerns: Two patients sustained complex foot injuries in traffic accidents, including multiple fracture dislocations and extensive degloving of the plantar skin. Diagnosis: Clinical inspection revealed significant degloving of the glabrous skin in both patients. Interventions: After fracture fixation, ICG fluorescence angiography-assisted debridement with immediate latissimus dorsi free flap reconstruction was performed. Outcomes: In both cases, this technique allowed a precise debridement with maximal preservation of the glabrous skin. The healing of the remaining glabrous skin was uneventful and the 6-month follow-up was characterized by stable soft tissues and satisfying ambulation. Lessons: ICG fluorescence angiography is a safe, user-friendly, and quick procedure with minimal risks, expanding the armamentarium of the reconstructive surgeon. It is highly useful for the debridement of extensive plantar degloving injuries and may also help to minimize the number of procedures and the risk of infection.

Application of indocyanine green in surgery: A review of current evidence and implementation in trauma patients

“…The tool expands the armamentarium for reconstructive surgeries. It is highly useful for decision-making during accurate debridement and soft tissue coverage of extensive plantar degloving before obvious demarcation, reducing the number of interventions and risk of infection[ 108 ].…”

Utility of Indocyanine Green Fluorescence Imaging in Wound Assessment

“…Appropriate debridement to preserve as much viable tissue as possible is the most critical procedure for successful reconstruction and long-term function. A recent study used ICG fluorescence imaging to evaluate degloved tissue perfusion of the plantar foot area in the early post-traumatic period which was highly useful for debridement and also for reducing the risk of infection [14]. ICG angiography was also utilized to assess tissue viability in an avulsed scalp, guiding the clinical de- cision to perform microanastomosis (Fig.…”

Perfusion Dynamics during Secondary Flap Debulking with Liposuction

“…In reconstructive microsurgery, ICG fluorescence angiography is mostly used for its predictive qualities regarding skin and flap survival. 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 By distinguishing between well-perfused and poorly perfused tissues, ICG fluorescence angiography is fundamental for intraoperative decision-making and allows precise tailoring in view of minimal postoperative complications. 19 20 21 22…”

“…1,2 In reconstructive microsurgery, ICG fluorescence angiography is mostly used for its predictive qualities regarding skin and flap survival. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] By distinguishing between well-perfused and poorly perfused tissues, ICG fluorescence angiography is fundamental for intraoperative decisionmaking and allows precise tailoring in view of minimal postoperative complications. [19][20][21][22] Because of real-time flow assessment, ICG fluorescence angiography is an accurate modality which has contributed to our understanding of flap dynamics and which is superior to the trained eye of the reconstructive surgeon.…”