SHARE @ Advocate Health - Midwest - Scientific Day: Retrospective Cohort Study of Microvascular Fluorescence Angiography (MFA) Use in Hyperbaric Oxygen Therapy Patients Following Lower Extremity Amputation Complicated by Flap Ischemia
 

Affiliations

Aurora St. Luke's Medical Center, Aurora UW Medical Group, Aurora Sinai Medical Center

Abstract

Background/Significance:

Microvascular Fluorescence Angiography (MFA) allows for assessment of focal tissue perfusion following an amputation. Sequential MFA studies provide visualization of initial microvasculature and evolving angiogenesis at an amputation site, allowing clinicians to assess the impact of Hyperbaric Oxygen Therapy (HBOT) throughout a patient’s recovery. In turn, MFA may then influence the prolongation or completion of HBOT. This study assessed whether MFA impacted the duration of HBOT following lower extremity distal amputation in patients who developed a postoperative ischemic compromised flap (“comp flap”).

Purpose:

While MFA provides valuable information regarding amputation site health, we must evaluate how this information alters hyperbaric care and patient outcomes. Only by investigating the merits and shortcomings of MFA can we consider this modality’s place amongst numerous other interventions available to our hyperbaric amputee patients.

Methods:

In this retrospective chart review, lower extremity (LE) amputation patients with clinical findings for comp flap and who also received HBOT were identified. The patients were divided into cohort group (underwent MFA imaging) and control group (no MFA imaging). HBOT duration and clinical outcomes were compared between groups.

Results:

267 patients who underwent LE amputation (101 cohorts/166 controls) were identified. Patients received between 1-60 HBOT treatments. Overall, the MFA group received more HBOT treatments than the control group: 46% of MFA patients received 11-20 treatments compared to 34% of controls; 30% of MFA patients received 21-30 treatments compared to 23% of controls; and 12% of MFA patients received 31 or more treatments compared to 9% of controls. Notably, one third (34%) of control patients received 10 or fewer HBOT treatments compared to 13% for the MFA group.

Conclusion:

MFA’s application in HBOT patient selection and influence on treatment duration has been promoted, however there is little information on direct impact. Interestingly, non-MFA patients status-post LE amputations were more likely to receive ≤10 treatments when compared to the MFA group. MFA patients were more likely to receive 11-20 treatments compared to the non-MFA group. Additionally, MFA appears to influence HBOT by increasing the number of treatments in toe amputation comp flap patients for all hyperbaric treatment course subgroups who received >10 HBOT. Once a patient surpasses 20 HBOT however, the impact of MFA on treatment duration is less robust. Further analyses are needed to understand competing factors as we explore MFA’s role in hyperbaric medicine.

Presentation Notes

Presented at Scientific Day; May 21, 2025; Park Ridge, IL.

Full Text of Presentation

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Document Type

Poster


 

Additional Files

BRB Revised and Submitted Scientific Day Abstract.docx (16 kB)
BRB Revised Abstract

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May 21st, 11:41 AM May 21st, 1:15 PM

Retrospective Cohort Study of Microvascular Fluorescence Angiography (MFA) Use in Hyperbaric Oxygen Therapy Patients Following Lower Extremity Amputation Complicated by Flap Ischemia

Background/Significance:

Microvascular Fluorescence Angiography (MFA) allows for assessment of focal tissue perfusion following an amputation. Sequential MFA studies provide visualization of initial microvasculature and evolving angiogenesis at an amputation site, allowing clinicians to assess the impact of Hyperbaric Oxygen Therapy (HBOT) throughout a patient’s recovery. In turn, MFA may then influence the prolongation or completion of HBOT. This study assessed whether MFA impacted the duration of HBOT following lower extremity distal amputation in patients who developed a postoperative ischemic compromised flap (“comp flap”).

Purpose:

While MFA provides valuable information regarding amputation site health, we must evaluate how this information alters hyperbaric care and patient outcomes. Only by investigating the merits and shortcomings of MFA can we consider this modality’s place amongst numerous other interventions available to our hyperbaric amputee patients.

Methods:

In this retrospective chart review, lower extremity (LE) amputation patients with clinical findings for comp flap and who also received HBOT were identified. The patients were divided into cohort group (underwent MFA imaging) and control group (no MFA imaging). HBOT duration and clinical outcomes were compared between groups.

Results:

267 patients who underwent LE amputation (101 cohorts/166 controls) were identified. Patients received between 1-60 HBOT treatments. Overall, the MFA group received more HBOT treatments than the control group: 46% of MFA patients received 11-20 treatments compared to 34% of controls; 30% of MFA patients received 21-30 treatments compared to 23% of controls; and 12% of MFA patients received 31 or more treatments compared to 9% of controls. Notably, one third (34%) of control patients received 10 or fewer HBOT treatments compared to 13% for the MFA group.

Conclusion:

MFA’s application in HBOT patient selection and influence on treatment duration has been promoted, however there is little information on direct impact. Interestingly, non-MFA patients status-post LE amputations were more likely to receive ≤10 treatments when compared to the MFA group. MFA patients were more likely to receive 11-20 treatments compared to the non-MFA group. Additionally, MFA appears to influence HBOT by increasing the number of treatments in toe amputation comp flap patients for all hyperbaric treatment course subgroups who received >10 HBOT. Once a patient surpasses 20 HBOT however, the impact of MFA on treatment duration is less robust. Further analyses are needed to understand competing factors as we explore MFA’s role in hyperbaric medicine.

 

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