ABSTRACT
We report a new technique for visualizing and measuring skin perfusion on a macroscopic scale using low doses of indocyanine green (0.3 mg/kg body weight). The method was first evaluated in the rat random cutaneous flap model and subsequently applied to determine skin perfusion in a patient with peripheral arterial occlusive disease (PAOD), a patient with forefoot necrosis due to diabetic microangiopathy, and a healthy volunteer. The observed kinetics of fluorescence appearance could only be explained by transition of the dye to a third compartment different from the blood plasma and having a greater affinity for indocyanine green. In PAOD reduced skin perfusion in the tissue surrounding the arterial ulcer could be clearly demonstrated, whereas skin perfusion in diabetic microangiopathy seems to be unaffected. Other potential clinical applications for the technique in dermatology and vascular and reconstructive surgery are briefly discussed.
Subject(s)
Angiography/methods , Diabetic Angiopathies/diagnosis , Leg Ulcer/diagnosis , Models, Biological , Photofluorography/methods , Skin/blood supply , Adult , Animals , Arteries , Diabetic Angiopathies/metabolism , Diabetic Angiopathies/surgery , Female , Humans , Indocyanine Green , Infrared Rays , Leg/blood supply , Leg Ulcer/metabolism , Leg Ulcer/surgery , Male , Middle Aged , Perfusion , Random Allocation , Rats , Rats, Sprague-Dawley , Surgical Flaps , Video RecordingABSTRACT
A 39-year-old woman with cutis marmorata telangiectatica congenita (CMTC) on the back presented with a 5-year history of pain in the involved area which initially occurred only on touch and cold exposure but was ultimately virtually constant. Histological examination of a skin biopsy specimen revealed an increased number of nerve fibres. The phlebectatic subcutaneous veins were demonstrable by NIR (near infrared) venoscopy.
