49 Indocyanine Green Angiography in the Surgical Evaluation of Partial Thickness Burn Wounds

Abstract

Abstract Introduction While treatment of 1st and 3rd degree burns is fairly well understood, second-degree burns pose a challenge. This can lead to delayed treatment, or unnecessary operations, either of which can lead to scarring, contractures, infections, and poor cosmetic outcomes. While Laser Doppler Imaging has been used to differentiate second degree burns it is not reliable in studying uneven surfaces, requires long scan times, and has limited penetration. ICG angiography, which has gained wide use in breast reconstruction, can circumvent many of these issues. In this study, we used ICG angiography to investigate 2nd degree burns in an effort to develop an objective measure to differentiate deep from superficial 2nd degree burns. Methods All patients with 2nd degree burns covering greater than 1% total body surface and consented to the study were enrolled. Exclusion criteria included iodide allergy and the inability to follow up. All burns presented within 48 hours of injury. Patients were evaluated with ICG imaging on presentation and re-imaged at 24-hour intervals up to 72 hours after the initial injury and at the time of excision. The patients were managed by a blinded Burn Surgeon, with follow up pictures performed at 2 weeks, 1 month, 6 months, and 1 year. All images were analyzed using software to determine if areas with different scores ended up receiving operative or conservative treatment. Results Thus far 6 patients have enrolled in the study. All patients presented following flash burns, with BSA ranging from 10–30%. Of the 6 patients, only one required operative treatment. For the five patients treated conservatively areas of burn presented with SPY Q readings ranging from 70–110. These readings improved universally with each subsequent image, often by 10–20 each image, although one burn was found to double its perfusion by 72 hours post-injury. In contrast, the patient requiring operative intervention presented with a SPY-Q reading of 20–30. While there was a minor improvement, the maximum reading the area of resection reached was only 40–50. The patient was eventually taken to the OR for debridement and STSG. Conclusions While these preliminary results are limited due to the small sample size of our population, we feel that this study demonstrates the utility of ICG angiography in the diagnosis of second-degree burns. Our previous work on a porcine model verified that SPY can be used to measure both vertical and horizontal burn progression, and our early results in this study show a sharp difference between the patients treated conservatively, and the one patient requiring operative intervention. Applicability of Research to Practice Using these results, we plan to develop an objective cut off that will serve as a benchmark for when operative intervention is required. And with a secondary objective to evaluate the level excision.