Evaluation of Burn Depth using Indocyanine Green: Discrepancies Between Macroscopic Visualization and the
Mary Junak1, Héctor García2, Aiping Liu1
1Department of Surgery, University of Wisconsin, Madison, WI, 53792, USA.
Plastic and Reconstructive Surgery
|March 10, 2026
Summary
Fluorescence imaging with indocyanine green (ICG) shows potential for assessing burn depth and healing. Further research is needed to overcome variability and integrate this technology into clinical burn management.
Area of Science:
- Biomedical Engineering
- Dermatology
- Medical Imaging
Background:
- Burn wound depth assessment is crucial for treatment but traditionally relies on subjective visual evaluation.
- Perioperative fluorescence imaging with indocyanine green (ICG) offers a potential objective method for burn depth evaluation.
Purpose of the Study:
- To explore the relationship between ICG angiography (ICGA), Second-window ICG (SWIG), and burn depth.
- To understand how ICGA and SWIG can guide prognosis and treatment in human burn wounds.
Main Methods:
- 14 patients with indeterminate or deep partial thickness burns underwent ICGA and SWIG imaging post-burn.
- Histologic evaluation of tissue biopsies was performed for correlation.
- In vitro studies assessed ICG uptake in heat-injured human skin cells using flow cytometry.
Main Results:
- ICGA perfusion parameters correlated with healing potential (no grafting required).
- SWIG fluorescence intensity correlated with histologic burn depth and necrotic regions, but with high interpatient variability.
- In vitro, ICG preferentially binds to necrotic cells, influencing SWIG signal based on cell type and injury severity.
Conclusions:
- Fluorescence imaging, including ICGA and SWIG, shows promise in aiding burn healing potential assessment.
- Challenges in imaging variability, interpretation, and clinical integration require further investigation for optimal use in burn management.
