Synapse - Assessment of wound perfusion with near-infrared angiography: A prospective feasibility study

Assessment of wound perfusion with near-infrared angiography: A prospective feasibility study Journal Article

Authors:	Manning-Geist, B. L.; Cowan, R. A.; Schlappe, B.; Braxton, K.; Sonoda, Y.; Long Roche, K.; Leitao, M. M. Jr; Chi, D. S.; Zivanovic, O.; Abu-Rustum, N. R.; Mueller, J. J.
Article Title:	Assessment of wound perfusion with near-infrared angiography: A prospective feasibility study
Abstract:	Objective: To assess the feasibility of quantitatively measuring skin perfusion before and after suture or staple skin closure of vertical laparotomies using indocyanine green (ICG) uptake with near-infrared angiography. Methods: This was a prospective, non-randomized feasibility study of patients undergoing surgery with a gynecologic oncology service from 2/2018–8/2019. Feasibility was defined as the ability to quantitatively measure ICG uptake adjacent to the wound at the time of skin closure in ≥ 80% of patients. Patients were assigned suture or staple skin closure in a sequential, non-randomized fashion. Skin perfusion was recorded using a near-infrared imaging system after ICG injection and measured by video analysis at predefined points before and after skin closure. Clinicodemographic, pre- and intraoperative details, and surgical secondary events were recorded. Results: Of 20 participants, 10 were assigned staple closure and 10 suture closure. Two patients (10%) achieved objective quantification of ICG fluorescence before and after laparotomy closure, failing the predefined feasibility threshold of ≥ 80%. Reasons for failed quantification included overexposure (12), insufficient ICG signal uptake (6), and insufficient video quality (2). Near-infrared angiography wound perfusion was subjectively appreciated intraoperatively in 85% (17/20) of patients before and after wound closure. Conclusions: Objective assessment of laparotomy skin closure with near-infrared angiography–measured perfusion did not meet the pre-specified feasibility threshold. Adjustments to the protocol to minimize overexposure may be warranted. The ability to subjectively appreciate ICG perfusion with near-infrared angiography suggests a possible role for near-infrared angiography in the real-time intraoperative assessment of wound perfusion, particularly in high-risk patients. © 2022 The Authors
Keywords:	laparotomy; indocyanine green; near-infrared angiography; skin closure; wound perfusion
Journal Title:	Gynecologic Oncology Reports
Volume:	40
ISSN:	2352-5789
Publisher:	Elsevier B.V.
Date Published:	2022-04-01
Start Page:	100940
Language:	English
DOI:	10.1016/j.gore.2022.100940
PROVIDER:	scopus
PMCID:	PMC8829563
PUBMED:	35169608
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85124039918&doi=10.1016%2fj.gore.2022.100940&partnerID=40&md5=3f93deafa8182560bd3ea448cb41ac3b
Notes:	Article -- Export Date: 1 March 2022 -- Source: Scopus