Fenn Gary, Kennedy Sharon, Morrison Colin, Dolan Roisin T
Department of Plastic, Reconstructive and Hand Surgery, St Vincent's University Hospital, Dublin, Ireland.
Department Radiology Medicine, St Vincent's University Hospital, Dublin, Ireland.
Trauma Case Rep. 2023 Sep 2;48:100923. doi: 10.1016/j.tcr.2023.100923. eCollection 2023 Dec.
Indocyanine green fluorescence angiography (ICG-FA) is a validated non-invasive imaging tool used to assess tissue perfusion and guide intra-operative decision making in many surgical disciplines. Clinical assessment of tissue perfusion following crush or degloving traumatic hand injuries presents a significant challenge. This case report supports the critical role of intra-operative ICG-FA as a decision aid in complex hand trauma. We propose ICG-FA will minimise unnecessary tissue debridement, negating complex soft tissue reconstructive surgery and ultimately expediting tissue healing and return to function for hand trauma patients. A 35-year-old right hand dominant manual labourer presented to the emergency department after sustaining a crush injury to his right hand. Examination under anaesthetic revealed a comminuted open fracture of middle finger P2 with compromised soft tissue coverage. A formal assessment of hand perfusion was performed using a triad of clinical assessment, critical judgement and ICG-FA. The ICG-FA revealed a small skin flap affecting the dorsoradial P2 skin which was not perfused. This prompted meticulous minimal debridement of this tissue and prevented unnecessary over-debridement that would have resulted in complex soft tissue reconstruction. Currently the gold standard assessment for tissue perfusion in hand injuries is clinical judgement and is limited by subjective interobserver error [1]. IGA-FA has been proven to offer a real time assessment of tissue perfusion. This case demonstrates the use of ICG-FA as an adjunct to clinical examination and judgement, to optimise the accuracy of soft tissue perfusion assessment in complex hand trauma.
吲哚菁绿荧光血管造影（ICG-FA）是一种经过验证的非侵入性成像工具，用于评估组织灌注并指导许多外科领域的术中决策。挤压或脱套伤所致手部创伤后组织灌注的临床评估面临重大挑战。本病例报告支持术中ICG-FA作为复杂手部创伤决策辅助工具的关键作用。我们认为ICG-FA将减少不必要的组织清创，避免复杂的软组织重建手术，并最终加速手部创伤患者的组织愈合和功能恢复。一名35岁的右利手体力劳动者右手遭受挤压伤后被送往急诊科。麻醉下检查发现中指P2粉碎性开放性骨折，软组织覆盖受损。采用临床评估、批判性判断和ICG-FA三联法对手部灌注进行了正式评估。ICG-FA显示一个影响P2背桡侧皮肤的小皮瓣无灌注。这促使对该组织进行细致的最小清创，并防止了本会导致复杂软组织重建的不必要过度清创。目前，手部损伤组织灌注的金标准评估是临床判断，且受观察者间主观误差的限制[1]。ICG-FA已被证明能提供组织灌注的实时评估。本病例展示了ICG-FA作为临床检查和判断的辅助手段，用于优化复杂手部创伤中软组织灌注评估的准确性。
