Abstract
Complications remain despite conventional methods aimed at improving survivorship
of lower extremity amputations. High rates of wound dehiscence, readmission, and revision
surgery warrant the development of innovative methods to improve amputation survivorship.
One such method employs the use of indocyanine green dye (ICG); an inert chemical
injected intraoperatively which can be used to visualize dermal blood flow in real
time. There is little objective data available to help guide the use of indocyanine
green in limb salvage procedures. The present study compares a group of 31 patients
undergoing minor lower extremity amputation with the use of indocyanine green with
a control group of 62 patients in which traditional methods were used. Minimum follow-up
of 9 months was obtained, leaving 93 patients in total for analysis. Success was defined
as a healed amputation within 60 days of follow-up. Uneventful amputation healing
occurred in 35.5% and 33.9% of indocyanine green and control patients, respectively.
Overall, there was no significant difference in outcomes between groups (p = .965), or success versus failure (p = 1.0). Patient undergoing minor lower extremity amputation with the use of ICG fluorescence
angiography did not have statistically inferior outcomes to patients who underwent
amputations at the same level with traditional assessments of perfusion. Further research
involving the use of this technique is warranted.
Level of Clinical Evidence
Keywords
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References
- Rehospitalizations among patients in the Medicare fee-for-service program.New Engl J Med. 2009; 360: 1418-1428
- Risk factors and indications for readmission after lower extremity amputation in the American College of Surgeons National Surgical Quality Improvement Program.J Vasc Surg. 2014; 60: 1315-1324
- Intravenous and indocyanine green angiography.J Am Optom Assoc. 2004; 75: 743-755
- Intraoperative perfusion techniques can accurately predict mastectomy skin flap necrosis in breast reconstruction: results of a prospective trial.Plast Reconstr Surg. 2012; 129: 778-788
- Early postoperative detection of tissue necrosis in amputation stumps with indocyanine green fluorescence angiography.Vasc Endovasc Surg. 2010; 44: 269-273
- Nationwide trends in the epidemiology of diabetic foot complications and lower-extremity amputation over an 8-year period.BMJ Open Diabetes Res Care. 2009; 7e000795
- Improving outcomes for lower extremity amputations using intraoperative fluorescent angiography to predict flap viability.Vasc Endovasc Surg. 2018; 52: 16-21
- Assessment of tissue viability following amputation surgery using near-infrared fluorescence imaging with indocyanine green.Ann Vasc Surg. 2021; 78: 281-287
- Five year mortality and direct costs of care for people with diabetic foot complications are comparable to cancer.J Foot Ankle Res. 2020; 13: 1-4
- Prognostic value of the Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) classification in patients with no-option chronic limb-threatening ischemia.J Vasc Surg. 2018; 68: 1104-1113
- Quality control of the foot revascularization using indocyanine green fluorescence imaging.World J Surg. 2017; 41: 1919-1926
Article info
Publication history
Published online: July 28, 2022
Footnotes
Financial Disclosure: This research was supported in part by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number UL1TR002550. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Conflict of Interest: The authors declare no potential conflicts of interest with respect to research, authorship, and/or publication of this article.
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Copyright
Published by Elsevier Inc. on behalf of the American College of Foot and Ankle Surgeons.
