title: Indocyanine green fluorescence monitoring of perineal wound contamination in abdominoperineal resection: a preliminary report.
abstract: OBJECTIVE
  Surgical site infections (SSI) in an abdominoperineal resection (APR) occur more frequently than in other types of operations for patients with colorectal cancer. Perineal wounds are the most vulnerable sites, and they may be caused by stool contamination. Indocyanine green (ICG) fluorescence imaging, by which sensitive detection was possible, was used as a marker of perineal wound contamination.
  
  
  METHODS
  Indocyanine green was transanally injected to the rectum before operation, and fluorescence images were obtained during the operation in three patients who underwent APR.
  
  
  RESULTS
  One subject, in whom gross contamination was not visible, had an SSI, and a trace of ICG fluorescence was detectable in the perianal skin. The other two subjects, in whom skin preparation was completely performed until ICG contamination was eliminated, were free from SSI.
  
  
  CONCLUSIONS
  Our results suggested that a trace of stool contamination remained in the perineal skin field even after the usual antiseptic skin preparation. Furthermore, meticulous skin preparation is required to minimize stool contamination in APR patients.
authors.affiliation: Department of Surgery, Nara Social Insurance Hospital, Yamatokoriyama, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Kitai
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kawashima
authors.forename: Hideaki
authors.initials: H
authors.lastname: Fujii
authors.forename: Susumu
authors.initials: S
authors.lastname: Mashima
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Shimahara
mesh_terms: D000005:Abdomen / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004396:Coloring Agents; D005240:Feasibility Studies; D005243:Feces / Q000382:microbiology; D005260:Female; D005453:Fluorescence; D006801:Humans; D007208:Indocyanine Green; D008297:Male; D010502:Perineum / Q000382:microbiology* / Q000601:surgery*; D011859:Radiography; D012004:Rectal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013530:Surgical Wound Infection / Q000175:diagnosis* / Q000209:etiology
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green