Journal of the American College of Surgeons
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No objective technique exists to distinguish necrotic from viable tissue, risking over-excision in burns and loss of wound healing potential. Second window indocyanine green (SWIG) is a novel fluorescence-imaging modality being studied to identify residual solid tumors during oncological surgery. SWIG has also been shown to have avidity for necrosis in animal models, but translation of these findings to humans is lacking. The objective of this study was to evaluate SWIG in the identification of burn wound necrosis and compare it with previously published indocyanine green angiography (ICGA) techniques. ⋯ Our study confirmed that ICGA is an inconsistent and nonstandardized modality to evaluate burn injuries. In contrast, SWIG imaging is a potential imaging modality to objectively prognosticate burn wound healing potential and guide intraoperative burn excision. Further studies are needed to define ratios of fluorescence intensity values to guide surgical decision-making in burn excision and to better define how ICG is retained in necrotic tissue to enhance utility of SWIG in other disease processes.
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Laparoscopic cholecystectomy with fluorescent cholangiography using indocyanine green dye (FC) identifies extrahepatic biliary structures, potentially augmenting the critical view of safety. We aim to describe trends for the largest single-center cohort of patients undergoing FC in laparoscopic cholecystectomy. ⋯ In conclusion, this paper demonstrates improved operative outcomes with the use of FC through the consistent ability to delineate biliary anatomy, even in the setting of complex anatomy. No common bile duct injuries have occurred in our 7-year experience with FC. We recommend FC as the standard of care when performing laparoscopic cholecystectomies.
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Pilonidal disease is a common condition of the gluteal crease, affecting around 1 in 2,000 adolescents and young adults. 1 Traditional options for management of pilonidal disease include improved hygiene with or without hair removal or resection of the nidus. Given a high recurrence rate associated with hygiene alone, nidus resection is often recommended, even for patients with mild pilonidal disease, despite significant postoperative morbidity. We present a consecutive series of patients with mild pilonidal disease managed in a dedicated Pilonidal Care Clinic using an alternate approach directed toward source control: improved hygiene to limit debris in the gluteal crease, excision of midline pilonidal pits under local anesthesia to prevent intrusion of debris with drainage of any nidus present, and laser ablation of midline follicles to prevent new pits from forming. 2. ⋯ Mild pilonidal disease may be resolved with improved hygiene, pit excision, and laser epilation with minimal morbidity and no activity restrictions. Adoption of this approach may keep a large number of patients with pilonidal disease from undergoing unindicated resection.