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

• Main Authors: Beryl L. Manning-Geist (Author), Renee A. Cowan (Author), Brooke Schlappe (Author), Kenya Braxton (Author), Yukio Sonoda (Author), Kara Long Roche (Author), Mario M. Leitao Jr (Author), Dennis S. Chi (Author), Oliver Zivanovic (Author), Nadeem R. Abu-Rustum (Author), Jennifer J. Mueller (Author)
• Format: Book
• Published: Elsevier, 2022-04-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 2352-5789; 10.1016/j.gore.2022.100940
• Keywords: Indocyanine green; Wound perfusion; Near-infrared angiography; Laparotomy; Skin closure; Gynecology and obstetrics; RG1-991; Neoplasms. Tumors. Oncology. Including cancer and carcinogens; RC254-282
• Source: Gynecologic Oncology Reports, Vol 40, Iss , Pp 100940- (2022)

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.