title: Early postoperative detection of tissue necrosis in amputation stumps with indocyanine green fluorescence angiography.
abstract: 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.
authors.affiliation: Clinic of Vascular Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Zimmermann
authors.forename: Casper
authors.initials: C
authors.lastname: Roenneberg
authors.forename: Heiko
authors.initials: H
authors.lastname: Wendorff
authors.forename: Thomas
authors.initials: T
authors.lastname: Holzbach
authors.forename: Riccardo E
authors.initials: RE
authors.lastname: Giunta
authors.forename: Hans-Henning
authors.initials: HH
authors.lastname: Eckstein
mesh_terms: 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
chemical_list: D005456:Fluorescent Dyes; D007208:Indocyanine Green