Lighting the Way for Necrosis Excision Through Indocyanine Green Fluorescence-Guided Surgery
Jocelyn C Zajac1, Aiping Liu1, Adam J Uselmann2
1From the Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI (Zajac, Liu, Hassan, Faucher, Gibson).
Journal of the American College of Surgeons
|September 14, 2022
Summary
Second window indocyanine green (SWIG) imaging shows promise in distinguishing necrotic from viable burn tissue, unlike inconsistent indocyanine green angiography (ICGA). SWIG could guide burn excision and improve wound healing potential.
Area of Science:
- Medical Imaging
- Surgical Oncology
- Burn Care
Background:
- Objective assessment of burn wound necrosis is lacking, leading to potential over-excision and impaired healing.
- Second window indocyanine green (SWIG) is a novel fluorescence imaging technique with potential for necrosis detection.
- Previous studies showed SWIG avidity for necrosis in animal models, but human data is limited.
Purpose of the Study:
- To evaluate SWIG's efficacy in identifying burn wound necrosis in human subjects.
- To compare SWIG performance against established indocyanine green angiography (ICGA) techniques for burn assessment.
Main Methods:
- Utilized mouse, human skin xenograft, and human patient burn models.
- Performed brightfield and SWIG near-infrared imaging on macroscopic tissue samples.
- Correlated SWIG fluorescence with visual assessment and histological markers of necrosis (H&E, LDH stains).
Main Results:
- SWIG identified burn necrosis with signal characteristics inversely related to ICGA.
- Necrosis identification by SWIG was dependent on indocyanine green (ICG) dose and administration timing.
- SWIG fluorescence accurately delineated the interface between viable and nonviable burn tissue.
Conclusions:
- ICGA is an inconsistent and non-standardized method for evaluating burn injuries.
- SWIG imaging offers a potential objective method to predict burn wound healing and guide surgical excision.
- Further research is needed to establish fluorescence intensity thresholds for surgical decision-making and explore SWIG's utility in other conditions.
