The Use of Indocyanine Green Laser Angiography to Evaluate and Aid in Treating Traumatic Hand Injuries

Purpose: Indocyanine green laser angiography is an intraoperative technology which utilizes ICG fluorescent dye to access tissue perfusion in a real-time manner. It was popularized in breast reconstructive surgery to evaluate mastectomy flap perfusion. This visualization optimizes outcomes by predicting regions of possible tissue necrosis. We believe this adjuvant technology can be utilized in traumatic hand surgery and augment the clinical exam by differentiating between areas of adequate or inadequate perfusion.

Methods: Retrospective review of eight patients where ICG angiography was utilized intra-operatively.

Results: All eight patients in this study sustained hand/wrist trauma through various mechanisms.  Patient ages were from 12 to 56. One patient sustained a ring avulsion injury with soft tissue degloving.  There was clinical evidence of devascularization, but ICG angiography confirmed perfusion. In another case, a patient sustained near-circumferential lacerations of two fingers and was transferred to our institution by helicopter due to clinical concern for ischemic digits. ICG angiography displayed intact vascularity to these digits as was confirmed by surgical exploration. In yet five other near amputation cases, ICG angiography was used to evaluate perfusion preoperatively to determine surgical staging for revascularization of digits or tissue debridement in degloved areas. In a final case, the technology determined the optimal angiosome for reverse radial forearm flap in a palmar degloving injury.

Conclusion: ICG angiography aided our treatment decisions, helping us to formulate or change surgical plans, and allowed for more surgical confidence.  Going forward, we hope to determine whether it can be a cost effective tool to reduce operative time and prevent multiple trips to the OR.