Areas of viable tissue will metabolize the MB to the colorless metabolite leucomethylene blue, while nonviable areas will remain stained blue ( Fig. The burned tissue is immediately cleaned with saline-soaked laparotomy sponges and then debrided with a surgical scratch pad. After the surgical preparation has been cleaned off the area of interest, the entire burn is painted with a surgical sponge soaked in MB.
In this communication, we propose a technique to identify nonviable tissue, using methylene blue (MB) staining, to diminish inadequate or excessive debridement, as well as limit intraoperative blood loss ( Fig. 2 Use of infrared thermography has also been attempted with good preliminary results, but also requires additional, often unavailable, intraoperative equipment. In such cases, indocyanine green angiography offers one method however, its use is encumbered by additional intravenous injection timing and proprietary equipment. Therefore, plastic surgeons who treat burns must be familiar with secondary strategies for patients who present with burned tissue of uncertain viability. Moreover, while the use of tourniquets is helpful in treating extremity burns, bleeding tissue is a useful clinical endpoint for adequate debridement. Moreover, tangential excision can be associated with a significant blood loss. Complicating this reality are the potential anatomic and physiologic insults associated with resecting adjacent viable tissue, especially in patients with limited physiologic reserve, such as children or critically ill patients. 1 Inadequate debridement is a common source of complications when treating burn patients, leading to reconstructive failures, septic complications, and prolonged hospitalizations. While the gold standard of burn assessment is clinical examination, there is significant discordance between clinically and histologically nonviable tissue.
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