Lighting the Way for Necrosis Excision Through Indocyanine Green Fluorescence-Guided Surgery.
Lighting the Way for Necrosis Excision Through Indocyanine Green Fluorescence-Guided Surgery.
复制标题
通过吲哚菁绿荧光引导手术照亮坏死切除之路。
DOI：
10.1097/xcs.0000000000000329
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发表时间：
2022
影响因子：
5.2
通讯作者：
Gibson,AngelaLf
中科院分区：
文献类型：
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作者：
Zajac,JocelynC;Liu,Aiping;Uselmann,AdamJ;Lin,Christie;Hassan,SameehaE;Faucher,LeeD;Gibson,AngelaLf
背景：目前还没有客观的技术来区分坏死组织和存活组织，这可能会导致烧伤中过度切除和伤口愈合潜力丧失。第二窗口吲哚菁绿色（SWIG）是一种新的荧光成像模式正在研究中，以确定残留的实体肿瘤在肿瘤手术。SWIG也被证明在动物模型中对坏死具有亲和力，但这些发现缺乏对人类的翻译。本研究的目的是评估SWIG在烧伤创面坏死的识别和比较它与以前发表的吲哚菁绿色血管造影（ICGA）techniques.Study Design：本研究使用小鼠，人类皮肤异种移植和人类患者烧伤模型。对宏观组织样品进行了近红外场和SWIG近红外成像，然后将其冷冻保存，切片并分析显微荧光。SWIG荧光结果与视觉评估的烧伤伤口，以及坏死的组织学标志物使用苏木精和伊红和乳酸脱氢酶stains.RESULTS：我们发现，SWIG确定烧伤坏死的方式依赖于吲哚菁绿色（ICG）管理的剂量和时间，并有一个反向的荧光信号与ICGA相比。此外，SWIG荧光识别界面的活性和非活性tissue.CONCLUSION：我们的研究证实，ICGA是一个不一致的和非标准化的方式来评估烧伤。相比之下，SWIG成像是一种潜在的成像方式，可以客观地证实烧伤伤口愈合潜力并指导术中烧伤切除。需要进一步的研究来定义荧光强度值的比率，以指导烧伤切除中的手术决策，并更好地定义ICG如何保留在坏死组织中，以增强SWIG在其他疾病过程中的效用。
BACKGROUND:No objective technique exists to distinguish necrotic from viable tissue, risking over-excision in burns and loss of wound healing potential. Second window indocyanine green (SWIG) is a novel fluorescence-imaging modality being studied to identify residual solid tumors during oncological surgery. SWIG has also been shown to have avidity for necrosis in animal models, but translation of these findings to humans is lacking. The objective of this study was to evaluate SWIG in the identification of burn wound necrosis and compare it with previously published indocyanine green angiography (ICGA) techniques.STUDY DESIGN:This study used mouse, human skin xenograft and human patient burn models. Brightfield and SWIG near-infrared imaging were performed on macroscopic tissue samples, which were then cryopreserved, sectioned, and analyzed for microscopic fluorescence. SWIG fluorescence findings were correlated to visual assessment of the burn wound as well as histological markers of necrosis using hematoxylin and eosin and lactate dehydrogenase stains.RESULTS:We found that SWIG identified burn necrosis in a manner dependent on the dose and timing of indocyanine green (ICG) administration and had an inverse fluorescence signal compared with ICGA. Furthermore, SWIG fluorescence identified the interface of viable and nonviable tissue.CONCLUSION:Our study confirmed that ICGA is an inconsistent and nonstandardized modality to evaluate burn injuries. In contrast, SWIG imaging is a potential imaging modality to objectively prognosticate burn wound healing potential and guide intraoperative burn excision. Further studies are needed to define ratios of fluorescence intensity values to guide surgical decision-making in burn excision and to better define how ICG is retained in necrotic tissue to enhance utility of SWIG in other disease processes.