Wound Repair Regen. 2026 Sep-Oct;34(5):e70220. doi: 10.1111/wrr.70220.
ABSTRACT
Chronic wound healing depends on local wound-edge perfusion, which is not fully characterised by conventional vascular assessments. We evaluated whether quantitative periwound ring enhancement on indocyanine green angiography could predict 12-week wound healing. This retrospective cohort study included 71 patients with diabetic foot ulcers or pressure sores who underwent baseline indocyanine green angiography. Relative fluorescence intensity, time to peak, perfusion slope and ring continuity were quantified and integrated into an exploratory 0-8-point Perfusion Success Index. Forty-two patients achieved complete healing within 12 weeks and 29 did not. Healers showed higher relative fluorescence intensity, shorter time to peak, steeper perfusion slope, greater ring continuity and a higher Perfusion Success Index than non-healers (5.83 ± 1.45 vs. 3.24 ± 1.38, p < 0.001). The Perfusion Success Index demonstrated the highest overall discrimination for 12-week healing (area under the curve, 0.894; 95% confidence interval, 0.823-0.965); a cut-off of ≥ 5 yielded 83.3% sensitivity and 82.8% specificity. A clinical model including wound type, wound area, wound depth, infection and serum albumin had an area under the curve of 0.777, which increased to 0.908 after addition of the Perfusion Success Index (absolute increase in area under the curve, 0.131; p = 0.012). After bootstrap internal validation, the clinical-plus-index model retained favourable discrimination with an optimism-corrected area under the curve of approximately 0.87. Quantitative periwound ring enhancement on indocyanine green angiography may provide complementary prognostic information regarding wound-edge healing potential beyond conventional clinical assessment.
PMID:42895899 | DOI:10.1111/wrr.70220