Use of indocyanine green fluorescent angiography in a hyperbaric patient with soft tissue radiation necrosis: a case report.

INTRODUCTION

Indocyanine green fluorescent angiography (ICFA), commonly used to assess vascularity in patients with non-healing lower extremity wounds, is emerging as a useful adjunct for hyperbaric oxygen (HBO₂)therapy patients. We describe the use of ICFA to measure vascularity and help tailor an appropriate HBO₂ regimen in a patient with breast soft tissue radiation necrosis (STRN).

CASE REPORT: 67-year-old female with a history of right breast cancer treated two years previously with lumpectomy and radiation therapy (6200 cGy), developed open wounds in the right breast. A diagnosis of STRN was established; the patient completed 20 HBO₂ treatments, followed by surgical closure of the right breast wounds. Intraoperative ICFA demonstrated a focal area of hypovascularity at the medial margin of the incision. Due to a concern of suboptimal vascularity, the patient returned for additional HBO₂ treatments. ICFA was performed after eight postoperative HBO₂ treatments, and showed improved vascularity in the previously identified area of concern.

DISCUSSION: Studies of patients previously irradiated for head and neck cancer suggest that HBO₂-induced vascularity is apparent after approximately eight HBO₂ treatments and peaks around 20 treatments. The results from this case indicate that the doses of HBO₂ needed for adequate neovascularization in patients with STRN may be variable.

CONCLUSION

The use of ICFA may provide additional insight regarding HBO₂-induced angiogenesis. Additional studies are required to establish the correct number of HBO₂ treatments required for angiogenesis in previously irradiated patients with STRN, and to explore the role of ICFA in patients treated with HBO₂.