Diagnosis of burn depth using laser-induced indocyanine green fluorescence: a preliminary clinical trial.

Clinical assessment of burn depth is frequently inaccurate. In order to effectively plan the treatment of burn wounds, an accurate diagnosis of burn depth is desirable. A new method for evaluating the depth of burns by imaging the blood flow through the burned tissue using fluorescence from intravenously injected indocyanine green (ICG) dye illuminated with a 785-nm, near-infrared diode laser array was evaluated. Nine patients and 15 individual burn sites were studied. Five sites were classified by the ICG study as superficial second degree, four were deep-dermal second degree, and six were third degree. Etiology of the injuries included flame, contact burns, and scalds. The date postburn of the study ranged from 1 to 11 days. In all cases, the relative fluorescence levels (e.g. superficial second-degree burns yielded relatively bright fluorescence, third-degree burns appeared much darker than surrounding normal skin) were found to correlate well with actual burn depth as determined by histologic examination of biopsies and intraoperative clinical assessment.

[1]  N. McLean,et al.  New laser Doppler scanner, a valuable adjunct in burn depth assessment. , 1993, Burns : journal of the International Society for Burn Injuries.

[2]  B. Sørensen,et al.  Laser Doppler flowmetry measurements of superficial dermal, deep dermal and subdermal burns. , 1984, Scandinavian journal of plastic and reconstructive surgery.

[3]  R. Lawson,et al.  Thermographic assessment of burns and frostbite. , 1961, Canadian Medical Association journal.

[4]  K. Baker Binding of Sulfobromophthalein (BSP) Sodium and Indocyanine Green (ICG) by Plasma α1 Lipoproteins.∗ , 1966 .

[5]  D. Fabian,et al.  The reliability of clinical assessment of the depth of burns , 1977 .

[6]  B. Zawacki,et al.  AN EVALUATION OF PATENT BLUE V, BROMPHENOL BLUE, AND TETRACYCLINE FOR THE DIAGNOSIS OF BURN DEPTH , 1970, Plastic and reconstructive surgery.

[7]  J. Cantrell,et al.  Ultrasonic pulse-echo determination of thermal injury in deep dermal burns. , 1977, Medical physics.

[8]  J. Slakter,et al.  Adverse Reactions due to Indocyanine Green , 1994 .

[9]  A. M. Kahn,et al.  Burn wound biopsy. Multiple uses in patient management. , 1979, Scandinavian journal of plastic and reconstructive surgery.

[10]  B. Pruitt,et al.  Improvements in burn care. , 1980, JAMA.

[11]  W. Reid,et al.  A practical technique for the thermographic estimation of burn depth: A preliminary report , 1981 .

[12]  R. G. Cornell,et al.  Improvements in burn care, 1965 to 1979. , 1980, JAMA.

[13]  G. Leopold,et al.  B-mode ultrasonic echo determination of depth of thermal injury. , 1986, Burns, including thermal injury.

[14]  R P Cole,et al.  Thermographic assessment of burns using a nonpermeable membrane as wound covering. , 1991, Burns : journal of the International Society for Burn Injuries.

[15]  J A Bauer,et al.  Cutaneous 10 MHz ultrasound B scan allows the quantitative assessment of burn depth. , 1989, Burns, including thermal injury.

[16]  D. Heimbach,et al.  Early surgical excision versus conventional therapy in patients with 20 to 40 percent burns. A comparative study. , 1982, American journal of surgery.

[17]  J. Burke,et al.  The beneficial effect of early excision on clinical response and thymic activity after burn injury. , 1982, The Journal of trauma.

[18]  J. Callis,et al.  Multispectral imaging of burn wounds: a new clinical instrument for evaluating burn depth , 1988, IEEE Transactions on Biomedical Engineering.

[19]  D LaRossa,et al.  Evaluation of the burn wound with perfusion fluorometry. , 1983, The Journal of trauma.

[20]  V J Anselmo,et al.  Effect of evaporative surface cooling on thermographic assessment of burn depth. , 1977, Radiology.

[21]  F. Shiraga,et al.  Survey of complications of indocyanine green angiography in Japan. , 1994, American journal of ophthalmology.

[22]  D. Schoenfeld,et al.  Prompt Eschar Excision: A Treatment System Contributing to Reduced Burn Mortality , 1986, Annals of surgery.

[23]  Martin A. Afromowitz,et al.  Clinical Evaluation of Burn Injuries Using an Optical Reflectance Technique , 1987, IEEE Transactions on Biomedical Engineering.

[24]  J. Dingwall A CLINICAL TEST FOR DIFFERENTIATING SECOND FROM THIRD DEGREE BURNS. , 1943, Annals of Surgery.

[25]  P O Byrne,et al.  A laser Doppler scanner for imaging blood flow in skin. , 1991, Journal of biomedical engineering.

[26]  R. Anderson,et al.  Burn depth estimation using indocyanine green fluorescence. , 1992, Archives of dermatology.

[27]  J. Still,et al.  Decreasing length of hospital stay by early excision and grafting of burns. , 1996, Southern medical journal.

[28]  J E BENNETT,et al.  EVALUATION OF BURN DEPTH BY THE USE OF RADIOACTIVE ISOTOPES—AN EXPERIMENTAL STUDY , 1957, Plastic and reconstructive surgery.

[29]  J Hurley,et al.  Burn depth estimation by use of indocyanine green fluorescence: initial human trial. , 1995, The Journal of burn care & rehabilitation.

[30]  J Micheels,et al.  Clinical use of laser Doppler flowmetry in a burns unit. , 1984, Scandinavian journal of plastic and reconstructive surgery.

[31]  G L Wolf,et al.  Assessing burn wound depth using in vitro nuclear magnetic resonance (NMR). , 1986, The Journal of surgical research.

[32]  M E Hackett,et al.  The use of thermography in the assessment of depth of burn and blood supply of flaps, with preliminary reports on its use in Dupuytren's contracture and treatment of varicose ulcers. , 1974, British journal of plastic surgery.

[33]  E. Wood,et al.  A tricarbocyanine dye for continuous recording of dilution curves in whole blood independent of variations in blood oxygen saturation. , 1957, Proceedings of the staff meetings. Mayo Clinic.

[34]  R Königová,et al.  Validity of clinical assessment of the depth of a thermal injury. , 1983, Acta chirurgiae plasticae.

[35]  C. M. Leevy,et al.  Indocyanine green clearance as a test for hepatic function. Evaluation by dichromatic ear densitometry. , 1967, JAMA.

[36]  J. Still,et al.  Evaluation of the circulation of reconstructive flaps using laser-induced fluorescence of indocyanine green. , 1999, Annals of plastic surgery.

[37]  T. L. Barclay,et al.  Correlation of scald depth and hypertrophic scar formation , 1981 .

[38]  M. Stern,et al.  In vivo evaluation of microcirculation by coherent light scattering , 1975, Nature.

[39]  N. Nishioka,et al.  Biodistribution of indocyanine green in a porcine burn model: light and fluorescence microscopy. , 1997, The Journal of trauma.

[40]  D. Heimbach,et al.  Early excision and grafting vs. nonoperative treatment of burns of indeterminant depth: a randomized prospective study. , 1983, The Journal of trauma.

[41]  M. Afromowitz,et al.  Burn depth estimation--man or machine. , 1983, The Journal of trauma.

[42]  K. Kogure,et al.  Infrared absorption angiography of the fundus circulation. , 1970, Archives of ophthalmology.

[43]  N. Nishioka,et al.  Burn wound assessment in porcine skin using indocyanine green fluorescence. , 1999, The Journal of trauma.

[44]  S. Shaldon,et al.  The use of indocyanine green in the measurement of hepatic blood flow and as a test of hepatic function. , 1961, Clinical science.