Kamolz L-P, Andel H, Haslik W, Donner A, Winter W, Meissl G, Frey M
Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical School, University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria.
Burns. 2003 Dec;29(8):785-91. doi: 10.1016/s0305-4179(03)00200-6.
The key decision in the treatment of thermal injuries is the determination of the depth of the burn wound and the resultant decision on treatment options. The trend in the treatment of deep dermal and full thickness burns is toward very early excision and grafting to reduce the risk of infection, decrease scar formation, shorten hospital stay, and thereby reducing costs. Traditionally, this has involved serial clinical examinations, which involves primarily subjective judgment. Various objective examination techniques, supplementing the clinical diagnosis, have been suggested, but none has yet achieved widespread clinical acceptance. It has frequently been postulated that the blood flow in injured tissue indicates the extent of tissue damage. In this study, the clinical and scientific impact of indocyanine green (ICG) video angiography was tested in 20 patients. A wide range of depth of injury and etiology was included and analyzed. In all cases considered, video angiography was possible. The measurements and observations correlated well with the actual burn depth, which was assessed clinically (pre- and intraoperative assessment) and histologically (biopsies). In conclusion, ICG video angiography seems to be a practical method to describe vascular patency in a burn wound. The results indicate that ICG fluorescence angiography is a practical, accurate, and effective adjunct to clinical methods for estimating burn wound depth and thereby to assist in the rational assessment of treatment options. Furthermore, it allows an objective, qualitative and quantitative observation of the dynamic changes in burn wound depth, which are observed during the acute post-burn period, thereby indicating optimal timing of the first operation.
热损伤治疗中的关键决策是确定烧伤创面的深度，并据此决定治疗方案。深度真皮烧伤和全层烧伤的治疗趋势是尽早进行切除和植皮，以降低感染风险、减少瘢痕形成、缩短住院时间，从而降低成本。传统上，这需要进行系列临床检查，主要涉及主观判断。虽然有人提出了各种补充临床诊断的客观检查技术，但尚未得到广泛的临床认可。人们常常推测，受伤组织中的血流表明了组织损伤的程度。在本研究中，对20例患者进行了吲哚菁绿（ICG）视频血管造影的临床和科学影响测试。纳入并分析了广泛的损伤深度和病因。在所有考虑的病例中，视频血管造影都是可行的。测量和观察结果与实际烧伤深度密切相关，实际烧伤深度通过临床（术前和术中评估）和组织学（活检）进行评估。总之，ICG视频血管造影似乎是一种描述烧伤创面血管通畅情况的实用方法。结果表明，ICG荧光血管造影是一种实用、准确且有效的辅助临床方法，用于估计烧伤创面深度，从而有助于合理评估治疗方案。此外，它还能对烧伤后急性期观察到的烧伤创面深度动态变化进行客观、定性和定量观察，从而确定首次手术的最佳时机。
