Laser-Assisted Indocyanine Green Angiography Aids in the Reconstruction of Gustilo Grade IIIB Open Lower-Limb Fractures.

Abstract

Background The treatment of trauma to the lower extremities often carries a high risk of complications. To the best of our knowledge, no study has been published regarding the treatment of open lower-limb fractures using laser-assisted indocyanine green angiography (LA-ICG). Here we retrospectively evaluated LA-ICG-based therapeutic interventions and reported the use of LA-ICG and its results in this application. Patients and Methods Between January 2011 and December 2015, a total of 23 cases with Gustilo grade IIIB open lower-limb fractures were investigated. LA-ICG was used to demonstrate the presence of necrotic tissue and determine the range of debridement. We compared 13 patients treated using LA-ICG from 2013 to 2015 with 10 patients treated without LA-ICG from 2010 to 2013. We reviewed tissue necrosis and other outcomes of these patients. Results The tissue necrosis rate in the LA-ICG-used group was significantly lower than that in the LA-ICG-free group. There were also significant differences in the average number of instances of tissue necrosis per patient, debridements, and deep-site infections. There was no flap loss. Conclusion By using LA-ICG, not only plastic surgeons but also clinicians in all associated departments including orthopedics can perform early reliable debridement and share in trauma treatment planning. We will continue to accumulate similar cases and hope to further improve LA-ICG techniques.