Indocyanine Green Fluorescence Angiography in Minor Lower Extremity Amputations: A Useful Technique?

Complications remain despite conventional methods aimed at improving survivorship of lower extremity amputations. High rates of wound dehiscence, readmission, and revision surgery warrant the development of innovative methods to improve amputation survivorship. One such method employs the use of indocyanine green dye (ICG); an inert chemical injected intraoperatively which can be used to visualize dermal blood flow in real time. There is little objective data available to help guide the use of indocyanine green in limb salvage procedures. The present study compares a group of 31 patients undergoing minor lower extremity amputation with the use of indocyanine green with a control group of 62 patients in which traditional methods were used. Minimum follow-up of 9 months was obtained, leaving 93 patients in total for analysis. Success was defined as a healed amputation within 60 days of follow-up. Uneventful amputation healing occurred in 35.5% and 33.9% of indocyanine green and control patients, respectively. Overall, there was no significant difference in outcomes between groups (p = .965), or success versus failure (p = 1.0). Patient undergoing minor lower extremity amputation with the use of ICG fluorescence angiography did not have statistically inferior outcomes to patients who underwent amputations at the same level with traditional assessments of perfusion. Further research involving the use of this technique is warranted.

Ovine Forestomach Matrix in the Surgical Management of Complex Lower-Extremity Soft-Tissue Defects.

BACKGROUND: Chronic lower-extremity defects may lead to major amputations and have severe consequences on patient quality of life and mortality. Dermal matrices have become part of the reconstructive ladder and are often deployed in these scenarios to quickly build neodermis, especially in volumetric defects over exposed bone and tendon initially, to allow for subsequent closure by means of split-thickness skin grafting (STSG) or secondary intention. Ovine forestomach matrix (OFM) is a decellularized extracellular matrix (ECM) bioscaffold available in both sheet and particulate forms that can be used as a dermal matrix in various soft-tissue reconstruction procedures. METHODS: This retrospective case series evaluated the use of OFM products in the surgical reconstruction of 50 cases (n = 50) comprised of challenging lower-extremity defects from seven healthcare centers. Patient records were reviewed to identify comorbidities, defect cause, defect size, presence of exposed structures, Centers for Disease Control and Prevention contamination score, Wagner grade, OFM graft use, time to 100% granulation tissue, STSG use, overall time to heal, and postoperative complications. The primary study outcomes were time (days) to 100% granulation tissue formation, with secondary outcomes including overall time to wound closure (weeks), STSG take at 1 week, and complications. RESULTS: The results of this case series demonstrate OFM as a clinically effective treatment in the surgical management of complex lower-extremity soft-tissue defects with exposed structures in patients with multiple comorbidities. One application of OFM products was effective in regenerating well-vascularized neodermis, often in the presence of exposed structures, with a mean time to 100% granulation of 26.0 ± 22.2 days. CONCLUSIONS: These data support the use of OFM as a safe, cost-effective, and clinically effective treatment option for coverage in complex soft-tissue wounds, including exposed vital structures, and to shorten the time to definitive wound closure in complicated patient populations.