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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: A 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 post-operative 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 HBO-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.

DOI: 10.22462/5.6.2017.7