Indocyanine green dye angiography accurately predicts survival in the zone of ischemia in a burn comb model

• Published in: Burns 2014-08, Vol.40 (5), p.940-946
• Main Authors: Fourman, Mitchell S, Phillips, Brett T, Crawford, Laurie, McClain, Steve A, Lin, Fubao, Thode, Henry C, Dagum, Alexander B, Singer, Adam J, Clark, Richard A
• Format: Article
• Language: English
• Subjects: Angiography; Animals; Burn conversion; Burns - diagnosis; Coloring Agents; Critical Care; Disease Models, Animal; Female; Fluorescence; Indocyanine Green; Ischemia - diagnosis; Laser-Doppler Flowmetry; Near infrared; Perfusion Imaging - methods; Prediction; Skin - blood supply; Skin - diagnostic imaging; Skin - injuries; Swine; Tissue Survival
• ISSN: 0305-4179; 1879-1409
• DOI: 10.1016/j.burns.2013.10.017

Abstract Introduction Surgical evaluation of burn depth is performed via clinical observation, with only moderate reliability. While perfusion analysis has been proposed to enhance accuracy, no perfusion study has attempted to predict burn extension into the area of ischemia surrounding the original insult. We examined whether laser Doppler imaging (LDI) and indocyanine green (ICG) angiography predicted survival in the zone of ischemia in a porcine hot comb burn model. Methodology Six full-thickness wounds were created on 5 female Yorkshire swine using a validated porcine hot comb burn model. 4 full-thickness burns were created separated by 3 unburned interspaces that represent the zone of ischemia. The interspaces between each comb burn were monitored using LDI and ICG Angiography at 1, 4, 24, and 48 h after burn. Interspace survival was assessed via gross observation and blinded histological readings 7 days after injury. Results ICG Angiographic assessments of burn perfusion were significantly different in viable vs. non-viable interspace perfusion at 1 h, 4 h, and 48 h. Temporal plotting of a trend-line derived from quantitative perfusion measurements rendered two distinct graphs, allowing for the derivation of a predictive algorithm to separate viable and non-viable interspaces. LDI revealed no such prognostic trend. Conclusion Results from a validated porcine burn comb model suggest that ICG angiography has significant potential in the prediction of burn progression early after burn. However, the full potential of this technology cannot be determined until completion of clinical trials.