MargolisDJ, MalayDS, HoffstadOJ, 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.
MargolisDJ, MalayDS, HoffstadOJ, : 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.)| false
O’BrienPJ, CoxMW, ShortellCK, : Risk factors for early failure of surgical amputations: an analysis of 8,878 isolated lower extremity amputation procedures. J Am Coll Surg216: 836, 2013.10.1016/j.jamcollsurg.2012.12.04123521969)| false
IgariK, KudoT, ToyofukuT, et al.: Quantitative evaluation of the outcomes of revascularization procedures for peripheral arterial disease using indocyanine green angiography. Eur J Vasc Endovasc Surg46: 460, 2013.
IgariK, KudoT, ToyofukuT, : Quantitative evaluation of the outcomes of revascularization procedures for peripheral arterial disease using indocyanine green angiography. Eur J Vasc Endovasc Surg46: 460, 2013.2397327410.1016/j.ejvs.2013.07.016)| false
HicksCW, CannerJK, KaragozluH: Quantifying the costs and profitability of care for diabetic foot ulcers treated in a multidisciplinary setting. J Vasc Surg70: 233, 2019.10.1016/j.jvs.2018.10.097)| false
KimDU, RaoA, KaplanS, : The use of indocyanine green fluorescence angiography to assess perfusion of chronic wounds undergoing hyperbaric oxygen therapy. Undersea Hyperb Med45: 663, 2018.31158933)| false
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.
Corresponding author: Clark K. Brackney, DPM, Wake Forest Baptist Medical Center, 2150 Country Club Rd, Winston Salem, NC 27104. (E-mail: firstname.lastname@example.org)