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Prediction of Wound Healing Following Amputation Surgery Based on Near-Infrared Fluorescence with Indocyanine Green
Mo W Kruiswijk1, Roderick C Peul1, Floris P Tange1
1Department of Surgery, Leiden University Medical Center, Leiden, ZA, The Netherlands.
Background:
The objective of this study was to evaluate the predictive value of near-infrared (NIR) fluorescence imaging with indocyanine on wound healing complications within 6 weeks after lower extremity amputation.
Methods:
In this dual-center cohort study, patients undergoing minor (below ankle) or major (above ankle) amputations due to peripheral arterial disease (PAD) or diabetes mellitus, with perfusion assessment performed using indocyanine green (ICG) NIR fluorescence imaging, were included. Fluorescence videos were recorded using standardized protocols following intravenous administration of 0.1 mg/kg ICG. The fluorescence pattern and clinical perfusion were assessed intraoperatively as normal, questionable, or poor.
Results:
A total of 63 patients undergoing 85 amputations were included, with a near-equal distribution of minor (51%) and major (49%) procedures. Within the entire cohort, the sensitivity of a poor fluorescence pattern on wound healing complications was 46% and specificity was 90%, with a positive predictive value (PPV) of 85% and a negative predictive value (NPV) of 55%. In the major amputation group, a significant correlation was observed between the fluorescence pattern and the occurrence of necrosis (P = 0.008) as well as minor and major complications (P = 0.049; P = 0.013). Poor fluorescence patterns were significantly correlated with the occurrence of major complications following minor amputations (P = 0.027). In 57% (n = 12) of patients with a poor fluorescence pattern, the vascular surgeon assessed the clinical perfusion as good.
Conclusions:
Poor perfusion observed with ICG NIR fluorescence imaging can predict wound healing complications following lower extremity amputation. A difference was observed between the predictive values of minor and major amputations, with the PPV being considerably higher for minor amputations than major amputations. Clinical assessment of perfusion was inferior to ICG NIR fluorescence in detecting patients at risk.
