Variations in burn perfusion over time as measured by portable ICG fluorescence: A case series

The early determination of healing potential in indeterminate thickness burns may be difficult to establish by visual inspection alone, even for experienced burn practitioners. This case series explores the use of indocyanine green (ICG) fluorescence using portable bedside assessment as a potential tool for early determination of burn depth. Three subjects with indeterminate thickness burns had daily perfusion assessment using ICG fluorescence assessment using the SPY machine (SPY®, Lifecell Corp., NJ, USA) in addition to standard burn care. The fluorescence was quantified as a percentage of the perfusion of intact skin, and areas of hypo- and hyper-perfusion were indicated. The study was concluded when the burn surgeon, blinded to the ICG results, made a clinical determination of the need for skin grafting or discharge. The perfusion in areas of differing depth of burn were compared over the entire study period to determine both the magnitude of difference, and the point in the time course of healing when these changes became evident. Significant differences in perfusion were noted between burned areas of varying depth. These differences were evident as early as the first post-burn day, and persisted till the completion of the study. ICG fluorescence represents a potential adjunct in burn assessment in this first longitudinal study of its use; however much more systematic research will be required to judge the feasibility of clinical implementation.