Initial Experience of NIR-II Fluorescence Imaging-Guided Surgery in Foot and Ankle Surgery

Optical imaging in the second near-infrared(NIR-II;900-1880 nm)window is currently a popular research topic in the field of biomedical imaging.This study aimed to explore the application value of NIR-II fluorescence imaging in foot and ankle surgeries.A lab-established NIR-II fluorescence surgical navigation system was developed and used to navigate foot and ankle surgeries which enabled obtaining more high-spatial-frequency information and a higher signal-to-background ratio(SBR)in NIR-II fluorescence images compared to NIR-I fluorescence images;our result demonstrates that NIR-II imaging could provide higher-contrast and larger-depth images to surgeons.Three types of clinical application scenarios(diabetic foot,calcaneal fracture,and lower extremity trauma)were included in this study.Using the NIR-II fluorescence imaging technique,we observed the ischemic region in the diabetic foot before morphological alterations,accurately determined the boundary of the ischemic region in the surgical incision,and fully assessed the blood supply condition of the flap.NIR-II fluorescence imaging can help surgeons precisely judge surgical margins,detect ischemic lesions early,and dynamically trace the perfusion process.We believe that portable and reliable NIR-II fluorescence imaging equipment and additional functional fluorescent probes can play crucial roles in precision surgery.

Implications of obesity in patients with foot and ankle pathology

Obesity is a growing problem defined as a body mass index of greater than 30 kg/m2.It is predicted that by 2030,48.9%of adults will be classified as obese which expands surgical risk factors to a broad population while increasing healthcare costs at the same time in different socioeconomic groups.This specific population has been widely studied in multiple surgical fields and published studies have shown the implications in each of these fields.The impact of obesity on orthopedic surgical outcomes has been previously reported in several total hip and knee arthroscopy studies,with evidence indicating that obesity is strongly associated with an increased risk of post operative complications together with higher revision rates.In line with increasing interest on the impact of obesity in orthopedics,there has been a similar output of publications in the foot and ankle literature.This review article evaluates several foot and ankle pathologies,their risk factors associated with obesity and subsequent management.It provides an updated,comprehensive analysis of the effects of obesity on foot and ankle surgical outcomes,with the ultimate aim of educating both surgeons and allied health professionals about the risks,benefits,and modifiable factors of operating on obese patients.