Background: Intra- and postoperative assessment of perfusion with near-infrared fluorescence imaging is commonly used among plastic surgeons to evaluate the quality of a microsurgical anastomosis in free flaps.
Objective: As microsurgical anastomosis can be monitored with near-infrared fluorescence imaging there is potential concerning revascularized fingers and hands with soft tissue depths not exceeding 7 mm above anastomosis. In a case of a severe crush injury of the hand more information about the perfusion was necessary as clinical assessment suspected loss of perfusion.
Methods: A 49-year old male suffered from a severe crush injury of his left hand with dissection of the ulnar superficial palmar arterial arch and a lesion of median nerve. After revascularization and reconstruction of the nerve, the patient developed postoperatively a loss of perfusion of thumb and index finger. An evaluation of the perfusion status was obtained by fluorescence imaging after intravenous application of ICG.
Results: After intravenous application of ICG the near-infrared imaging showed a delayed but sufficient perfusion of the hand so that a salvage surgery was not indicated.
Conclusions: In scenarios of critical perfusion in revascularized fingers and hands, the perfusion control via application of ICG and near-infrared fluorescence imaging can be a helpful tool.
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