Current and Future Applications of Fluorescence Guidance in Orthopaedic Surgery.

Fluorescence-guided surgery (FGS) is an evolving field that seeks to identify important anatomic structures or physiologic phenomena with helpful relevance to the execution of surgical procedures. Fluorescence labeling occurs generally via the administration of fluorescent reporters that may be molecularly targeted, enzyme-activated, or untargeted, vascular probes. Fluorescence guidance has substantially changed care strategies in numerous surgical fields; however, investigation and adoption in orthopaedic surgery have lagged. FGS shows the potential for improving patient care in orthopaedics via several applications including disease diagnosis, perfusion-based tissue healing capacity assessment, infection/tumor eradication, and anatomic structure identification. This review highlights current and future applications of fluorescence guidance in orthopaedics and identifies key challenges to translation and potential solutions.

Cardiac amyloidosis possibly secondary to Agent Orange exposure.

Much research has focused on the association between the toxic metabolites of the tactical herbicide Agent Orange and several blood cancers, including systemic amyloid light-chain (AL) amyloidosis. Here we present a rare case of heart failure secondary to cardiac AL amyloidosis as a consequence of Agent Orange exposure. An elderly man was transferred to the intensive care unit for a suspected gastrointestinal bleed and decompensation of congestive heart failure. An echocardiogram suggested restrictive cardiomyopathy, and an abdominal fat pad biopsy confirmed amyloid involvement. The diagnosis of systemic AL amyloidosis was made following a free lambda to free kappa light chain ratio >3:1. Upon discussion with the patient, significant exposure to Agent Orange during deployment was affirmed. Subsequent care was taken over by the Veterans Affairs Medical Center.

Rectus sheath hematoma following enoxaparin administration.

Low-molecular-weight heparin, including enoxaparin, has efficacy comparable to that of unfractionated heparin and is considered the first-line option for thromboprophylaxis due to a decreased risk profile. This paper presents a rare case of epigastric artery rectus sheath hematoma following enoxaparin injection, resulting in multiorgan failure secondary to hemorrhagic shock. Discussion of this case may assist clinicians in the recognition and treatment of similar cases.