Delayed perfusion evaluation in extremity trauma.

Area of Science:

• Trauma surgery
• Vascular imaging
• Microsurgery

Background:

• Achieving stable, non-infected wounds is crucial for extremity trauma reconstruction outcomes.
• Timely and adequate debridement is essential for optimal wound healing.
• Understanding tissue perfusion is vital for effective debridement following severe trauma.

Observation:

• Indocyanine green (ICG) angiography is a valuable tool for evaluating tissue circulation.
• ICG angiography can assess perfusion in the zone of injury, especially when circulation is compromised.
• This technique plays a role in flap surgeries and assessing perfusion in trauma cases.

Findings:

• ICG angiography initially demonstrated good circulation in a severely mangled extremity.
• A subsequent, alternative application of ICG angiography revealed a lack of blood flow in the same injured area.
• This highlights the dynamic nature of perfusion assessment in complex trauma.

Implications:

• ICG angiography can provide critical, real-time information on tissue perfusion in extremity trauma.
• The technique's utility extends beyond flap viability assessment to include detecting compromised circulation.
• Dynamic ICG angiography may aid in surgical decision-making for debridement and reconstruction in mangled extremities.