Early postoperative detection of tissue necrosis in amputation stumps with indocyanine green fluorescence angiography.
OBJECTIVE
Amputations of the lower extremity due to irreversible ischemic tissue loss are performed as distally as possible. Therefore, oftentimes wound-healing disorders develop, requiring additional surgical treatment.


METHODS
The amputations stumps of 10 patients with irreversible ischemic tissue loss due to arteriosclerosis were investigated within 72 hours postoperatively with indocyanine green (ICG) fluorescence.


RESULTS
For 6 of the investigated stumps, no perfusion deficit could be seen through fluorescence angiography. All stumps displayed primary healing. In the fluorescence angiography of 3 amputations, stump perfusions deficits predicted later tissue necrosis and had to be amputated again in a second operation. One amputation wound showed a small ICG perfusion deficit that represented a blood clot.


CONCLUSIONS
Indocyanine green fluorescence angiography allows a perfusion analysis of amputation stumps and therefore a prediction of the expected tissue necrosis. This tool may allow reliable prediction of amputation level.
Zimmermann
Alexander
A
Clinic of Vascular Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
Roenneberg
Casper
C
Wendorff
Heiko
H
Holzbach
Thomas
T
Giunta
Riccardo E
RE
Eckstein
Hans-Henning
HH
D000368:Aged; D000671:Amputation, Surgical / Q000009:adverse effects*; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D042241:Early Diagnosis; D005260:Female; D005451:Fluorescein Angiography; D005456:Fluorescent Dyes; D005734:Gangrene; D006801:Humans; D007208:Indocyanine Green; D007511:Ischemia / Q000209:etiology / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D035002:Lower Extremity / Q000098:blood supply* / Q000473:pathology / Q000601:surgery*; D008297:Male; D009336:Necrosis; D011183:Postoperative Complications / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D011237:Predictive Value of Tests; D012039:Regional Blood Flow; D012086:Reoperation; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing
D005456:Fluorescent Dyes; D007208:Indocyanine Green