advertising
-
1
Driver VR, Fabbi M, Lavery LA, et al.: The costs of diabetic foot: the economic case for the limb salvage team. J Vasc Surg 52: 178, 2010.
-
2
Margolis DJ, Malay DS, Hoffstad OJ, et al.: Economic burden of diabetic foot ulcers and amputations: Data Points #3. Data Points Publication Series [Internet], Agency for Healthcare Research and Quality (US), Rockville, MD, 2011.
-
3
O’Brien PJ, Cox MW, Shortell CK, et al.: Risk factors for early failure of surgical amputations: an analysis of 8,878 isolated lower extremity amputation procedures. J Am Coll Surg 216: 836, 2013.
-
4
Igari K, Kudo T, Toyofuku T, et al.: Quantitative evaluation of the outcomes of revascularization procedures for peripheral arterial disease using indocyanine green angiography. Eur J Vasc Endovasc Surg 46: 460, 2013.
-
5
Mothes H, Dönicke T, Friedel R, et al.: Indocyanine-green fluorescence video angiography used clinically to evaluate tissue perfusion in microsurgery. J Trauma 57: 1018, 2004.
-
6
Pestana IA, Coan B, Erdmann D, et al.: Early experience with fluorescent angiography in free-tissue transfer reconstruction. Plast Reconstr Surg 123: 1239, 2009.
-
7
Anthony T, Roberts J, Modrall JG: Transmetatarsal amputation: assessment of current selection criteria. Am J Surg 192: e8, 2006.
-
8
Perry D, Bharara M, Armstrong DG, et al.: Intraoperative fluorescence vascular angiography: during tibial bypass. J Diabetes Sci Technol 6: 204, 2012.
-
9
Li K, Zhang Z, Nicoli F, et al.: Application of indocyanine green in flap surgery: a systematic review. J Reconstr Microsurg 34: 77, 2018.
-
10
Hicks CW, Canner JK, Karagozlu H: Quantifying the costs and profitability of care for diabetic foot ulcers treated in a multidisciplinary setting. J Vasc Surg 70: 233, 2019.
-
11
Tohmasi S, Fujitani RM, Donayre CE, et al.: Plantar flap necrosis following transmetatarsal amputation predicted with intraoperative fluorescence angiography. ACS Case Rev Surg 2: 4, 2019.
-
12
Kim DU, Rao A, Kaplan S, et al.: The use of indocyanine green fluorescence angiography to assess perfusion of chronic wounds undergoing hyperbaric oxygen therapy. Undersea Hyperb Med 45: 663, 2018.
Assessment of Flap Viability for Complex Transmetatarsal Amputation Using Indocyanine Green Fluorescent Angiography: A Case Study
Search for other papers by Clark K. Brackney in
Current site
Google Scholar
PubMed
Search for other papers by Ivo A. Pestana in
Current site
Google Scholar
PubMed
Search for other papers by Hayden L. Hoffler in
Current site
Google Scholar
PubMed
Search for other papers by Cody D. Blazek in
Current site
Google Scholar
PubMed
Despite advancements in the treatment of diabetic patients with “at-risk” limbs, minor and major amputations remain commonplace. The diabetic population is especially prone to surgical complications from lower extremity amputation because of comorbidities such as renal disease, hypertension, hyperlipidemia, microvascular and macrovascular disease, and peripheral neuropathy. Complication occurrence may result in increases in hospital stay duration, unplanned readmission rate, mortality rate, number of operations, and incidence of infection. Skin flap necrosis and wound healing delay secondary to inadequate perfusion of soft tissues continues to result in significant morbidity, mortality, and cost to individuals and the health-care system. Intraoperative indocyanine green fluorescent angiography for the assessment of tissue perfusion may be used to assess tissue perfusion in this patient population to minimize complications associated with amputations. This technology provides real-time functional assessment of the macrovascular and microvascular systems in addition to arterial and venous flow to and from the flap soft tissues. This case study explores the use of indocyanine green fluorescent angiography for the treatment of a diabetic patient with a large dorsal and plantar soft-tissue deficit and need for transmetatarsal amputation with nontraditional rotational flap coverage. The authors theorize that the use of indocyanine green may decrease postoperative complications and cost to the health-care system through fewer readmissions and fewer procedures.
advertising
