Early detection of microcirculatory perfusion changes with a high resolution, real time laser doppler imaging camera–frostbite case study

• Published in: BMJ case reports Vol. 2011; no. sep19 1; p. bcr0620114404
• Main Authors: Erba, Paolo, Harbi, Pascal, Thacher, Tyler, Pries, Axel, Ambrosio, Giuseppe, Raffoul, Wassim
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 19.09.2011; BMJ Publishing Group
• Series: Novel diagnostic procedure
• Subjects: Adult; Amputation; Cameras; Europe (West); Fingers & toes; Fingers - blood supply; Fingers - surgery; Frostbite - diagnosis; Frostbite - surgery; Humans; Injuries; Laser-Doppler Flowmetry - methods; Male; Microcirculation; Molecular weight; Mountaineering; Novel Diagnostic Procedure; Toes - blood supply; Toes - surgery; Unknown
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr.06.2011.4404

A 41-year-old male presented with severe frostbite that was monitored clinically and with a new laser Doppler imaging (LDI) camera that records arbitrary microcirculatory perfusion units (1–256 arbitrary perfusion units (APU’s)). LDI monitoring detected perfusion differences in hand and foot not seen visually. On day 4–5 after injury, LDI showed that while fingers did not experience any significant perfusion change (average of 31±25 APUs on day 5), the patient’s left big toe did (from 17±29 APUs day 4 to 103±55 APUs day 5). These changes in regional perfusion were not detectable by visual examination. On day 53 postinjury, all fingers with reduced perfusion by LDI were amputated, while the toe could be salvaged. This case clearly demonstrates that insufficient microcirculatory perfusion can be identified using LDI in ways which visual examination alone does not permit, allowing prognosis of clinical outcomes. Such information may also be used to develop improved treatment approaches.