Laser-assisted Fluorescent Angiography to Assess Tissue Perfusion in the Setting of Traumatic Elbow Dislocation

In the surgical setting, the most accepted technique for measuring tissue perfusion includes subjective identification, with visual and tactile inspections of the tissue, performed by a surgeon. Recently, fields such as ophthalmology, plastic surgery, and other surgical specialties, such as cardiac, vascular, and transplant surgery, have seen the emergence of laser-assisted fluorescent angiography (LAFA) to visualize real-time tissue perfusion during procedures.

The case of an 80-year-old woman, who presented with a wound over the left medial elbow following a subacute recurrent elbow dislocation, illustrates the use of this technology in the field of orthopedics. Initially, the patient was treated at an outside facility where the dislocation was reduced, and she was placed in a long arm splint. With concern of recurrent dislocation and wound development, she presented to the authors with a complex wound measuring about 9 cm x 5 cm with variable thickness ranging from 0 mm to 5 mm in depth. Her initial emergent irrigation and debridement and wound management was assisted by LAFA and the administration of indocyanine green to guide debridement and determine viable wound margins. After staging with external fixation and a negative pressure wound dressing, she later returned for skin grafting and healed uneventfully.

In conjunction with plastic surgeons, the orthopaedic team utilized LAFA for debridement that led to both a successful wound repair and skin grafting procedure.