Role of Indocyanine Green Fluorescence to Assess Skin Vascularity in Peripheral Vascular Disease

OBJECTIVES: The objective is to assess the level of amputation based on the skin vascularity using indocyanine fluorescence. BACKGROUND: Patients with chronic limb ischemia have a risk of amputation within 1 year and reamputation due to impaired wound healing postamputation. Therefore, the assessment of tissue perfusion and viability before the planned surgery can minimize the chances of reamputation. To qualify the level of tissue perfusion, near-infrared (NIR) fluorescence imaging is promising. METHODS: The study includes adult patients suffering from peripheral vascular disease and in need of amputation. Indocyanine green (ICG) NIR fluorescence is performed on an individual planned for amputation before surgery. Following Intravenous Administration ICG, NIR fluorescence intensity of amputation is recorded and Video is analysed. Based on the intensity of fluorescence the images are divided as "low fluorescence" "no fluorescence" and "normal fluorescence". RESULTS: Successful ICG fluorescence was performed in 10 patients, out of which six patients showed "low fluorescence" (66.6%), and out of which six patients did not develop postoperative necrosis. Four patients showed "no fluorescence" (33.3%), and the same four patients developed skin necrosis postamputation. CONCLUSION: ICG NIR fluorescence imaging was able to predict postoperative skin necrosis in four patients. The potential of predicting wound healing using ICG NIR fluorescence imaging will help to understand the burden of amputation surgery on health care.