[abstract]ENHANCED TISSUE PERFUSION AFTER HYPERBARIC OXYGEN THERAPY DEMONSTRATED BY LASER-ASSISTED INDOCYANINE GREEN IMAGING

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[abstract]ENHANCED TISSUE PERFUSION AFTER HYPERBARIC OXYGEN THERAPY DEMONSTRATED BY LASER-ASSISTED INDOCYANINE GREEN IMAGING

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Title: [abstract]ENHANCED TISSUE PERFUSION AFTER HYPERBARIC OXYGEN THERAPY DEMONSTRATED BY LASER-ASSISTED INDOCYANINE GREEN IMAGING
Author: Millman, MP; Steinkraus, LW; Claus, PL; Jacobson, SR
Abstract: Introduction: Hyperbaric oxygen therapy (HBO2T) is used to treat patients with acutely compromised surgical wound tissue flaps after reconstruction or soft tissue late radiation injury wounds in conjunction with surgical debridement of necrotic tissue. The ability at the time of surgical intervention to identify ischemic tissue that has the potential to become well perfused tissue by HBO2T can save compromised tissue. We present the use of intraoperative laser-assisted indocyanine green imaging (LIGI) to identify compromised tissue that can benefit from HBO2T Materials and methods: A 51-year-old female with a history of Stage IIB (T2N1M0) invasive ductal breast carcinoma, nipple-sparing mastectomy, axillary lymph node dissection, and expander placement six months prior, post-operative hemotherapy and 6000 cGy radiation therapy, completed one week prior to presentation, developed breast MSSA soft tissue infection, fever (38.5 deg C) and purulent wound drainage. She was treated with antibiotic therapy, tissue expander removal, intraoperative microvascular perfusion LIGI mapping directed wound debridement Surgical Days 0 and 4, wound VAC therapy (changed Surgical Days 4 and 7), and latissimus dorsi musculocutaneous flap placement Day 11. The patient underwent eight 90-minute HBO2T sessions, 105kPa (2 ATA); five before the flap, and three after the flap. Intraoperative microvascular perfusion LIGI mapping of the left breast Days 0, 4, demonstrated small areas of necrotic tissue which were debrided but also demonstrated surrounding areas of decreased perfusion not evident on visual exam.Results: LIGI-directed surgical wound debridement, identified enhanced tissue perfusion of marginally perfused areas and readiness for flap placement after HBO2T therapy. No necrotic tissue was evident after surgical debridement on Day 4. Conclusion: Ischemic tissue adjacent to necrotic tissue has been demonstrated in the research setting. Intra-operative LIGI mapping clearly identified ischemic tissue which was amenable to HBO2T, thus enhancing tissue perfusion and saving compromised tissue suffering from subacute radiation injury.
Description: Undersea and Hyperbaric Medicine : Journal of the Undersea and Hyperbaric Medical Society, Inc.
URI: http://archive.rubicon-foundation.org/10470
Date: 2012

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  • UHMS Meeting Abstracts
    This is a collection of the published abstracts from the Undersea and Hyperbaric Medical Society (UHMS) annual meetings.

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