Early postoperative detection of tissue necrosis in amputation stumps with indocyanine green fluorescence angiography
Alexander Zimmermann1, Casper Roenneberg, Heiko Wendorff
1Clinic of Vascular Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
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.
Conclusion:
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.
