Perfusion control of a partial revascularized hand via application of Indocyanine green (ICG) and Near-infrared Fluorescence Imaging
Issue title: Selected papers of the 36th Conference of the German Society for Clinical Microcirculation and Hemorheology, 5–8. June, 2017, Greifswald, Germany
Guest editors: M. Jünger, A. Krüger-Genge and F. Jung
Affiliations: [a] University Center for Plastic, Hand and Reconstructive Surgery, University of Regensburg, Caritas Hospital St. Josef, Regensburg, Germany
| [b] University Center for Plastic, Hand and Reconstructive Surgery, University of Regensburg, University Hospital, Regensburg, Germany
Correspondence:
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Corresponding author: Dr. Catharina Strauss, University Center for Plastic, Hand and Reconstructive Surgery, University of Regensburg, Caritas Hospital St. Josef, Landshuter Straße 65, 93053 Regensburg, Germany. Tel.: +49 782 3110; Fax: +49 782 3115; E-mail: cstrauss@caritasstjosef.de.
Abstract: BACKGROUND:Intra- and postoperative assessment of perfusion with near-infrared fluorescence imaging is commonly used among plastic surgeons to evaluate the quality of a microsurgical anastomosis in free flaps. OBJECTIVE:As microsurgical anastomosis can be monitored with near-infrared fluorescence imaging there is potential concerning revascularized fingers and hands with soft tissue depths not exceeding 7 mm above anastomosis. In a case of a severe crush injury of the hand more information about the perfusion was necessary as clinical assessment suspected loss of perfusion. METHODS:A 49-year old male suffered from a severe crush injury of his left hand with dissection of the ulnar superficial palmar arterial arch and a lesion of median nerve. After revascularization and reconstruction of the nerve, the patient developed postoperatively a loss of perfusion of thumb and index finger. An evaluation of the perfusion status was obtained by fluorescence imaging after intravenous application of ICG. RESULTS:After intravenous application of ICG the near-infrared imaging showed a delayed but sufficient perfusion of the hand so that a salvage surgery was not indicated. CONCLUSIONS:In scenarios of critical perfusion in revascularized fingers and hands, the perfusion control via application of ICG and near-infrared fluorescence imaging can be a helpful tool.
