Potential of near-infrared fluorescence image-guided debridement in trauma surgery

Abstract

This case report presents the use of near-infrared fluorescence (NIRF) imaging using indocyanine green (ICG) and its potential for the evaluation of soft tissue viability in a traumatic case. Standard implementation of this novel imaging modality might decrease the number of surgical debridement procedures in complex traumatic wounds.

Optimizing Indocyanine Green Fluorescence Angiography in Reconstructive Flap Surgery: A Systematic Review and Ex Vivo Experiments

“…In the author's institution, this system is used in daily practice for perioperative tissue perfusion evaluation as well as for mapping of lymphatic collecting vessels in the outpatient clinic. 21,22 Experiments were performed using ICG diluted within 40 mg/mL albumin in a 0.9% NaCl dilution. This was done accordingly as ICG is considered to bind to albumin in vivo, which modifies its optical properties; 40 mg/mL was chosen as a stable point within the normal reference range for serum albumin, which is 35 to 55 g/L.…”

Fasciocutaneous anterolateral thigh flaps for complex abdominal wall reconstruction after resection of enterocutaneous fistulas and the role of indocyanine green angiography: a pilot study

“…To minimize postoperative complications, it is important to assess tissue perfusion intraoperatively as immediate debridement of insufficiently perfused portions of both the ALT flap and abdominal skin edges might reduce postoperative wound complications. Current evaluation of tissue perfusion depends highly on the surgeon’s experience and is found to be an unreliable predictor of perfusion [ 18 ]. Therefore, the use of Indocyanine Green Angiography (ICGA) is suggested to improve postoperative outcomes in flap surgery [ 19 ].…”

“…When exposed to near-infrared excitation, it reemits fluorescent light, which enables in-depth visualization of blood vessels. This innovative technique allows for real-time imaging of tissue perfusion and aids in performing accurate excision of non-vital tissue intraoperatively [ 18 , 19 ].…”

Delayed perfusion evaluation in extremity trauma

“…ICG angiography can help determine if there is poor circulation prior to it being noticeable clinically, which aids in determining whether or not to continue with debridement vs reconstruction. 4 Though previously reported as such, 1 observing good perfusion after a severe extremity trauma may not be an indication of health circulation as more tissue necrosis may be encountered over time. Even though we have not encountered a publication that shows negative and positive predictive values of ICG angiography, no to poor signals following injection of ICG could be a good predictor for poor circulation.…”

“…In order to perform the best reconstruction possible, a stable and non-infected wound is essential, in which timely, meticulous and adequate debridement is very important. 1,2 In current practice, we prefer to keep patients in the hospital and perform daily or every-other-day debridement until the wound is stable enough to either close or perform reconstructive surgeries. Aside from clinical evaluation, indocyanine green (ICG) angiography may be another useful tool in determining tissue viability as well as debridement level.…”