Potential of near-infrared fluorescence image-guided debridement in trauma surgery

Introduction

Adequate and early evaluation of tissue viability is of great importance in the treatment of open fractures of an extremity with comprehensive soft-tissue defects. Early, thorough debridement of all non-viable tissue is essential in treating these fractures since inadequate initial debridement may be accompanied by an increased risk of infection and nonunion. Final closure strategy should be postponed until the wound is ‘stabilized’, defined by the presence of a viable wound bed and the absence of necrotic tissue. Assessment of the viability of soft tissues and bone is generally based on the discretion of the surgeon’s subjective judgement.

Near-infrared fluorescence (NIRF) imaging can provide a more objective assessment of (soft) tissue viability. After intravenous administration of a contrast agent with fluorescent characteristics in the near-infrared (NIR) light spectrum (e.g. indocyanine green (ICG)) the surgeon can capture real-time enhanced tissue detection and characterization using a dedicated camera system. This innovative imaging method allows for indepth (maximum penetration depth of up to 1.5 centimeter) visualization of target-tissues including a wide variety of anatomical structures. NIRF is widely used by plastic surgeons to assess tissue perfusion in free flap surgeries and to study the lymphatic system. With the current report the potential added clinical value of NIRF imaging in combination with ICG is illustrated for enhanced debridement of traumatic wounds in the lower extremity.

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