Improving Outcomes for Lower Extremity Amputations Using Intraoperative Fluorescent Angiography to Predict Flap...

Area of Science:

• Vascular Surgery
• Medical Imaging
• Wound Healing

Background:

• Peripheral vascular disease often leads to lower extremity amputations (LEAs).
• High readmission rates (nearly 25%) within 30 days are linked to wound complications.
• Minimizing these complications is a key area of interest in vascular surgery.

Purpose of the Study:

• To evaluate intraoperative fluorescent angiography (IFA) as a tool for predicting skin flap viability.
• To assess the sensitivity and specificity of absolute and relative tissue perfusion values in LEAs.
• To determine the clinical utility of IFA in lower extremity amputation procedures.

Main Methods:

• Retrospective review of IFA with indocyanine green (ICG) dye in LEAs.
• Analysis of data from 13 patients undergoing 17 amputations between 2013 and 2014.
• Evaluation of absolute perfusion values (APVs) and relative perfusion values (RPVs) for predicting skin flap viability.

Main Results:

• A relative perfusion value (RPV) of ≤31% demonstrated 100% sensitivity and specificity for skin flap viability.
• Absolute perfusion values (APVs) showed limited predictive capability (50% sensitivity, 64% specificity).
• Six amputations (35%) required revision, with 14 patients proceeding to proximal amputation.

Conclusions:

• Intraoperative fluorescent angiography (IFA) is a safe and easily implementable tool for vascular surgeons during LEAs.
• RPVs derived from IFA show strong correlation with predicting skin flap viability.
• APVs were not reliable predictors of flap success or failure; patient comorbidities and vasopressor use may influence outcomes.