Intraoperative Fluorescence Angiography: A Review of Applications and Outcomes in War-Related Trauma

Green, J. Marshall; Sabino, Jennifer; Fleming, Mark E.; Valerio, Ian L.

doi:10.7205/milmed-d-14-00632

Cited by 33 publications

(26 citation statements)

References 30 publications

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“…Intraoperative indo-cyanine green laser angiography (ICGLA) has also been used as a guidance tool for complex debridement in heavily contaminated wounds, soft tissue avulsion injuries, amputation stumps, and flap design and assessment [ 28 ]. In a retrospective series, intra-operative plans were modified due to perfusion related issues in 35 out of 186 (18.8 %) patients, as detected by ICGLA.…”

Section: Reviewmentioning

confidence: 99%

Changing paradigms in lower extremity reconstruction in war-related injuries

2016

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BackgroundBallistic high-energy trauma has substantially increased the severity of non-fatal extremity injuries incurred in modern warfare. Expedient medical care, refinement in surgical techniques, and soft tissue coverage have brought about a paradigm shift in the management of lower extremity wounds during the last decade with an increased emphasis on limb salvage.MethodsA literature-based study was conducted to analyze reconstructive modalities based on the location, depth, and severity of wounds, as well as mechanism of injury, concomitant vascular injuries and open fractures, choice of flap, timing of definitive reconstruction, and complications.ResultsExtremity injuries account for over 60 % of injuries in the recent conflicts in Iraq and Afghanistan, with the majority secondary to explosive devices. The severity of these injuries is profound compared with civilian registries, and conventional injury scoring systems have failed to accurately predict outcomes in combat trauma. The mainstay of treatment is serial debridement, negative pressure therapy, fracture stabilization, and treatment of concomitant injuries by the forward medical teams with subsequent definitive reconstruction after transport to an advanced military treatment facility. Autologous reconstruction with free tissue transfer and pedicled flaps remains the primary modality for soft tissue coverage in limb salvage. Adjunct innovative modalities, such as external tissue expansion, dermal substitutes, and regenerative matrices, have also been successfully utilized for limb salvage.ConclusionLower extremity injuries account for the vast majority of injuries in modern warzones. Explosive devices represent the most common mechanism of injury, with blast impact leading to extensive soft tissue injuries necessitating complex reconstructive strategies. Serial debridement, negative pressure therapy, and autologous reconstruction with free tissue transfer and pedicled flaps remain the mainstay of treatment in recent conflicts.

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Section: Reviewmentioning

confidence: 99%

Changing paradigms in lower extremity reconstruction in war-related injuries

2016

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“…Necrosis is a common indicator of the occurrence and development of various diseases and is also one of the major risk factors for accelerated deterioration of diseases. If proper diagnosis and intervention are not achieved in a timely manner, the evolution of necrosis in vital organs may lead to fatal outcomes 1 2 3 4 . Therefore, highly sensitive detection and precise boundary delineation of necrotic lesions are crucial for clinical diagnosis and surgical treatment in order to achieve complete removal of the necrotic tissue as well as to minimize the loss of healthy tissue 5 6 .…”

mentioning

confidence: 99%

“…The indirect approaches have the disadvantages of inaccurate estimation of the necrotic margin and a short observation window 7 9 . For example, indocyanine green (ICG) has been used for intraoperative fluorescence angiography to detect tissue ischemia 4 based on its insufficient delivery to the ischemic area in the observation window (several minutes) after intravenous (IV) administration. However, this indirect approach cannot distinguish between the necrotic tissue and reversible ischemic tissue 13 .…”

mentioning

confidence: 99%

Illuminating necrosis: From mechanistic exploration to preclinical application using fluorescence molecular imaging with indocyanine green

Fang

Wang

Zeng

et al. 2016

Sci Rep

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Tissue necrosis commonly accompanies the development of a wide range of serious diseases. Therefore, highly sensitive detection and precise boundary delineation of necrotic tissue via effective imaging techniques are crucial for clinical treatments; however, no imaging modalities have achieved satisfactory results to date. Although fluorescence molecular imaging (FMI) shows potential in this regard, no effective necrosis-avid fluorescent probe has been developed for clinical applications. Here, we demonstrate that indocyanine green (ICG) can achieve high avidity of necrotic tissue owing to its interaction with lipoprotein (LP) and phospholipids. The mechanism was explored at the cellular and molecular levels through a series of in vitro studies. Detection of necrotic tissue and real-time image-guided surgery were successfully achieved in different organs of different animal models with the help of FMI using in house-designed imaging devices. The results indicated that necrotic tissue with a 0.6 mm diameter could be effectively detected with precise boundary definition. We believe that the new discovery and the associated imaging techniques will improve personalized and precise surgery in the near future.

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“…[45][46][47][48] Angiographic methods employ a contrast agent and track its distribution and transit time in the vascular bed of interest in order to visualize the lumen of larger vessels, track the supply and transit of blood to the capillary bed, and image lymphatic vessels. In the vast majority of instances, this is done using an intravenously administered bolus dose of the contrast agent.…”

Section: Indocyanine Green-angiographymentioning

confidence: 99%

“…The workhorse dye for clinical angiographic measurements has been the NIR dye ICG. It is widely used in humans for a number of indications, [45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60] and there are specific ICG imaging products on the market for wound assessment and intraoperative assessment of perfusion.…”

Section: Indocyanine Green-angiographymentioning

confidence: 99%

Review of near-infrared methods for wound assessment

Sowa

Kuo²,

et al. 2016

J. Biomed. Opt

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Intraoperative Fluorescence Angiography: A Review of Applications and Outcomes in War-Related Trauma

Cited by 33 publications

References 30 publications

Changing paradigms in lower extremity reconstruction in war-related injuries

Changing paradigms in lower extremity reconstruction in war-related injuries

Illuminating necrosis: From mechanistic exploration to preclinical application using fluorescence molecular imaging with indocyanine green

Review of near-infrared methods for wound assessment

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