Precise Marking for Burn Excision by Using Indocyanine Green Angiography

Sir: Dealing with burn wounds with indeterminate depth remains a major problem in burn excision. The accuracy of clinical assessment of indeterminate burn wounds was reported to be as low as 50 percent.1 Indocyanine green angiography, which yields a high accuracy of 100 percent and has increasing support in the literature, could potentially aid this issue.1,2 However, evidence on how to use indocyanine green angiography effectively in burn practice is still lacking.2 We would like to present that indocyanine green angiography could be further applied and contributed to the precise excision of burn wounds. A video demonstration was made to illustrate the process and provide examples. [See Video (online), which shows precise marking for burn excision. The junction of superficial and deep burn wounds can be marked while performing indocyanine green angiography. Later, the wounds can be excised along the marking.] A patient with indeterminate burn wound was injected intravenously with 0.5 mg/kg of indocyanine green (Diagnogreen Injection; Daiichi Sankyo Propharma, Japan). The Fluobeam 800 (Fluoptics, Grenoble, France) clinical system was used, and the wound was placed under its viewer. Using the 33 percent of maximal perfusion criteria to differentiate between superficial second-degree burn (brighter) and deep second-degree burn (darker),1,3 the junction of superficial and deep areas can be marked while performing indocyanine green angiography. The marker does not interfere with indocyanine green angiography interpretation. Later, the wounds can be excised along the marking. We hope that this method can provide an insight on how to use indocyanine green angiography productively in a clinical setting and can contribute tremendously to the way we perform burn excision. {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video.","caption":"This video shows precise marking for burn excision. The junction of superficial and deep burn wounds can be marked while performing indocyanine green angiography. Later, the wounds can be excised along the marking.","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_0ez8q876"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} DISCLOSURE None of the authors has a financial interest in any of the products or devices mentioned in this article. Apinut Wongkietkachorn, M.D.Division of Plastic and Reconstructive SurgeryDepartment of SurgeryFaculty of MedicineMae Fah Luang UniversityChiang Rai, Thailand Palakorn Surakunprapha, M.D.Kengkart Winaikosol, M.D.Division of Plastic and Reconstructive SurgeryDepartment of SurgeryFaculty of MedicineKhon Kaen UniversityKhon Kaen, Thailand Nuttapone Wongkietkachorn, M.D.Division of Plastic and Reconstructive SurgeryDepartment of SurgeryQ ClinicBangkok, Thailand Supawich Wongkietkachorn, M.D.Department of SurgeryFaculty of MedicineThammasat UniversityPathum Thani, Thailand