Fluorescence microangiography to guide management of non-healing wounds [poster]
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Introduction/Background: Treatment of non-healing wounds is often complicated by poor perfusion. Tissues need a constant supply of blood and oxygen to ensure adequate wound healing. Currently, the most reliable method for assessing these wounds is clinical gestalt. TCPO2 is often used to measure tissue perfusion, though this modality has multiple drawbacks. Fluorescence microangiography is increasingly being recognized as a useful tool by providing real-time visual and quantitative assessments of perfusion to guide treatment decisions in patients with complicated wounds. We discuss two patients whose management changed based on the results of their microangiography studies.
Materials and Methods: Two patients with non-healing wounds underwent evaluation with the LUNA fluorescence microangiography device. After consent and time out, a peripheral IV was started on the patient for the injection of 2.5mL indocyanine green (ICG) dye. A still photo of the target is taken for future reference. We then injected the ICG dye followed by a saline flush. Images were obtained at 7.5 frames per second and captured the ingress and egress of ICG dye to the target area. Results: The first patient was an 87-year-old woman with ischemic changes to the 4th and 5th digits of her right foot. Initial plan was to perform a transmetatarsal amputation. After evaluation with fluorescence microangiography she underwent a 4th and 5th digit amputation and went on to heal without complication. The second patient was a 63-year-old man with a history of PAD and a non-healing post-surgical wound from a great toe amputation. Based on his fluorescence microangiography evaluation his initial hyperbaric course of 20 treatments was extended to 30 treatments and he ended up healing well. Summary/Conclusions: Fluorescence microangiography is a promising tool in the evaluation of complex wounds.