Recommended Citation
Narula G, Banks B, Gunasekara P, et al. The Impact of Microvascular Fluorescence Angiography (MFA) on Healing and Outcomes of Hyperbaric Oxygen Therapy Patients Following Lower Extremity Amputations Complicated by Flap Ischemia. Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Abstract
Background/Significance:
Microvascular Fluorescence angiography (MFA) evaluates focal tissue perfusion and facilitates determination of ongoing or resolving ischemia. Our department utilizes MFA to validate or revise treatment plans for compromised surgical flaps in patients receiving hyperbaric oxygen therapy (HBOT). This study assessed whether the use of MFA impacted outcomes of patients with toe amputation compromised flaps who underwent HBOT guided by MFA compared to those who did not receive MFA.
Purpose:
To assess healing outcomes of MFA guided HBOT of compromised flaps of toe amputations.
Methods:
In this retrospective chart review study from 1/1/16 to 3/31/25, outcomes of healing, time to heal, additional amputations and readmission rates were compared for adult patients with compromised flaps after toe amputations. One cohort underwent MFA in conjunction with HBOT (n=129); the second cohort did not receive MFA (n=254). Analysis included Chi-square test, Fisher's test, and Wilcoxon rank sum test.
Results:
A total of 383 patients underwent a median of 17 (IQR 9-25) HBOT sessions: a median 15 (IQR 7-23) in the non- MFA group vs. 20 (IQR 14-28) with MFA (p <0.01). Over half of patients (56%) healed in both groups (non-MFA and MFA). Readmission rates were similar for non-MFA (42%) and MFA (36%) groups (p=0.64). Median time to heal from the 1st HBOT was 96 days (IQR 46, 161) in non-MFA group vs 75.5 days (IQR 42.5-148.5) in the MFA group (p=0.36). Median time to heal from last HBOT was 68 days (IQR 28.5-142.5) in non-MFA group vs 54.5 days (IQR 22.5-121.5) in the MFA group (p=0.18). Of the non-healed patients (n=169), a higher amputation was completed for 79% of non- MFA vs. 93% of the MFA group (p=0.001).
Conclusion:
Driven by objective data, patients receiving MFA underwent more HBOT sessions and demonstrated favorable trends towards shorter healing times, lower re-admission rates, and fewer subsequent procedures among non-healed groups. Even though the wounds in the MFA group showed a higher acuity and flap compromise, the overall healing rates between groups were similar. MFA fosters definitive early identification of a non-viable flap which substantiates the need for a more proximal amputation to ensure closure and healing. These findings suggest that MFA may assist in optimizing HBO utilization and limb salvage. Further prospective studies are warranted to clarify which patient populations derive the greatest benefit from MFA-guided HBOT.
Presentation Notes
Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Full Text of Presentation
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Document Type
Oral/Podium Presentation
The Impact of Microvascular Fluorescence Angiography (MFA) on Healing and Outcomes of Hyperbaric Oxygen Therapy Patients Following Lower Extremity Amputations Complicated by Flap Ischemia
Background/Significance:
Microvascular Fluorescence angiography (MFA) evaluates focal tissue perfusion and facilitates determination of ongoing or resolving ischemia. Our department utilizes MFA to validate or revise treatment plans for compromised surgical flaps in patients receiving hyperbaric oxygen therapy (HBOT). This study assessed whether the use of MFA impacted outcomes of patients with toe amputation compromised flaps who underwent HBOT guided by MFA compared to those who did not receive MFA.
Purpose:
To assess healing outcomes of MFA guided HBOT of compromised flaps of toe amputations.
Methods:
In this retrospective chart review study from 1/1/16 to 3/31/25, outcomes of healing, time to heal, additional amputations and readmission rates were compared for adult patients with compromised flaps after toe amputations. One cohort underwent MFA in conjunction with HBOT (n=129); the second cohort did not receive MFA (n=254). Analysis included Chi-square test, Fisher's test, and Wilcoxon rank sum test.
Results:
A total of 383 patients underwent a median of 17 (IQR 9-25) HBOT sessions: a median 15 (IQR 7-23) in the non- MFA group vs. 20 (IQR 14-28) with MFA (p <0.01). Over half of patients (56%) healed in both groups (non-MFA and MFA). Readmission rates were similar for non-MFA (42%) and MFA (36%) groups (p=0.64). Median time to heal from the 1st HBOT was 96 days (IQR 46, 161) in non-MFA group vs 75.5 days (IQR 42.5-148.5) in the MFA group (p=0.36). Median time to heal from last HBOT was 68 days (IQR 28.5-142.5) in non-MFA group vs 54.5 days (IQR 22.5-121.5) in the MFA group (p=0.18). Of the non-healed patients (n=169), a higher amputation was completed for 79% of non- MFA vs. 93% of the MFA group (p=0.001).
Conclusion:
Driven by objective data, patients receiving MFA underwent more HBOT sessions and demonstrated favorable trends towards shorter healing times, lower re-admission rates, and fewer subsequent procedures among non-healed groups. Even though the wounds in the MFA group showed a higher acuity and flap compromise, the overall healing rates between groups were similar. MFA fosters definitive early identification of a non-viable flap which substantiates the need for a more proximal amputation to ensure closure and healing. These findings suggest that MFA may assist in optimizing HBO utilization and limb salvage. Further prospective studies are warranted to clarify which patient populations derive the greatest benefit from MFA-guided HBOT.
Affiliations
Aurora St. Luke’s Medical Center, Aurora Sinai Medical Center, Aurora UW Medical Group