The Role of ICG Angiography in Decision Making About Skin-Sparing in Pediatric Acute Trauma
Tao Han1, Buhao Sun1, Weidong Wang1
1Department of Burns and Plastic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China.
Insights
Indocyanine green (ICG) angiography helps surgeons decide on skin-sparing techniques for acute pediatric trauma, significantly reducing postoperative necrosis risk. This imaging method proves valuable in managing complex pediatric injuries.
Area of Science:
- Plastic Surgery
- Pediatric Surgery
- Trauma Surgery
Background:
- Indocyanine green (ICG) angiography is established for evaluating skin flap perfusion in reconstructive surgery.
- Its utility in guiding skin-sparing decisions for acute pediatric trauma requires further investigation.
Purpose of the Study:
- To assess the role of ICG angiography in surgical decision-making for skin-sparing in pediatric acute trauma.
- To evaluate the impact of ICG angiography on preventing postoperative necrosis in pediatric trauma patients.
Main Methods:
- Retrospective analysis of 19 pediatric patients with acute trauma (Jan 2019 - Sep 2021).
- Comparison of ICG angiography with clinical judgment for assessing skin tissue viability.
- Intraoperative decisions based on wound characteristics, tissue perfusion, and defect size.
- Postoperative quantification of tissue perfusion using vascular imaging software.
Main Results:
- ICG angiography-guided treatment led to successful outcomes in 18 out of 19 patients (94.7%), avoiding postoperative necrosis.
- One patient with right forearm trauma experienced partial necrosis.
- Independent complications included hypertrophic scar and local infection, managed conservatively.
Conclusions:
- ICG angiography demonstrates potential in minimizing postoperative necrosis in acute pediatric trauma.
- It serves as a valuable adjunctive tool for surgeons in making informed skin-sparing decisions for pediatric trauma.
- Further research can validate its role in optimizing surgical management of pediatric trauma.
Background:
Indocyanine green (ICG) angiography has proven useful in assessing skin flap perfusion in plastic and reconstructive surgeries. This research aimed to explore its role in decision making about skin-sparing in children's acute trauma.
Methods:
A total of 19 patients suffering with acute trauma from January 2019 to September 2021 were retrospectively assessed. Both ICG angiography and clinical judgment were performed to evaluate skin tissue viability. The intraoperative decisions for each case depended on the specific condition of the traumatic wound, including tissue perfusion, skin defect area, and location of the wound. Postoperative vascular imaging software was used to quantify the tissue perfusion, and the duration of postoperative follow-up was from 6 to 18 months.
Results:
Among them, 18 (94.7%) patients experienced treatments according to ICG angiography and did not develop postoperative necrosis. One case with right forearm trauma suffered from partial necrosis. Hypertrophic scar and local infection were the independent complications, which were managed by symptomatic treatment.
Conclusion:
ICG angiography may reduce the risk of postoperative necrosis and renders a promising adjunctive technique for surgeons to make reasonable decisions in skin sparing in acute pediatric trauma.
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