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Authors: Prof. Robin Williams and Gigi Williams

Applications of the Sodium Fluorescein technique:
Blood Flow

Application Notes Reference
Bowel Sodium fluorescein fluorescence determined blood supply to sections of the intestine during a resection of the large bowel. Lange & Boyd 1942
Peripheral blood supply Described the application of the fluorescein technique to a range of peripheral vascular problems, eg., diagnosis of thrombotic occlusion, calculation of level for amputation, and differential diagnosis of thromboangiitis obliterans. Lange & Boyd 1944
Blood supply and ulcers Used sodium fluorescein successfully to ascertain the presence of intact vascular apparatus prior to grafting large ulcers. Lange 1944
Gangrene An assessment of blood flow to areas of gangrene following cold damage. Crimson et al. 1947
Burns - second and third degree If the tissue fluoresces yellow - second degree. If there is blue or purple reflection and no yellow fluorescence-third degree. Still 1951
Blood flow to the brain Used sodium fluorescein to investigate whether extracellular space in the central nervous system was responsible for the phenomenon of the blood-brain barrier. Hoffman & Olszewski 1961
Skin sloughs Used the technique to predict skin sloughs at the time of operation and to determine the viability of pedicle flaps and skin grafts. Concluded that the fluorescein technique was a safe, simple and the inexpensive method for predicting the location of skin sloughing after radical operations and amputations. Myers 1962
Arterial blood supply Fluorescein dye used to delineate the arterial supply to various parts of the head and neck during surgery. Showed photographs of a range of applications, including infusion of a liver and facial artery. Schaeffer & Baldwin 1970
Viability of arterialized flaps Showed the value of the technique and recommended routine fluorescein examination wherever a major flap was to be manipulated. McCraw et al. 1977
Viability of bowel Described the evaluation of ischaemic bowel viability. Stolar & Randolph 1978
Circulation & burns Described a technique for delineating the circulatory supply to superficial burns. Finseth 1979
Assessment of burns Described the use of the technique in assessing burn depth and the adequacy of blood flow. Suggested it was useful in determining whether deep skin grafting was required or not. Fluorescence photos taken between 48 and 72 hours. Leonard et al. 1980
Viability of intestine Found the technique was excellent for value and reliability in intra-operative testing of intestinal viability. Marfuggi & Greenspan 1981
Intestinal blood supply Compared two fluorescein filtration techniques for looking at the viability of intestinal blood supply and concluded that narrow cut interference filters performed best. Lanzafame et al. 1982
Blood flow Described application for the assessment of blood flow in surgery. Welch 1982
Burn injury Used a polaroid camera for the technique and claimed that this made it a very easy and simple technique to apply. Zuckerman 1983
Blood flow in ischaemia Measurement of blood flow in severely ischaemic patient. Gosain et al. 1999
Nipple Circulation Measurement of blood flow to nipples post reduction mammaplasty. Perbeck et al. 1991
Flap viability Assessment of flap viability with notes of safety. Morykwas et al. 1991
Necrosis Assessment of skin and muscle necrosis. Morris et al. 1993


  • Crimson, J. and Fuhrman, F., 1947, "Studies on gangrene following cold injury: the use of fluorescein as an indicator of local blood flow," J. Clin. Investig. 26:259- 268.
  • Finseth, F.,1979, "Photographic documentation of the fluorescein test," Plast. Reconstr. Burg. 63:834-835.
  • Gosain, A., Lewis, F. and Upton, R. 1991, "Relationship between skin fluorescence and blood flow in normal and in chronically ischaemic subjects dosed with Fluorescein" J. Pharm Sci : 7: 632-637.
  • Hoffman, J. and Olszewski, J., 1961, "A study of the mechanism of the blood- brain barrier," Neurology 11:1081 - 1085.
  • Lange, K. and Boyd, L., 1942, "The use of fluorescein to determine the adequacy of the circulation," Med. Clin. N. Am.26(3):943-952.
  • Lange, K., 1944, "The vascular prerequisites of successful skin grafting," Surgery 15:85-89.
  • Lange, K. and Boyd, L., 1944, "Use of fluorescein method in establishment of diagnosis and prognosis of peripheral vascular diseases," Arch. Int. Med.74:175-184.
  • Lanzafame, R. et al. , 1982, "Fluorescein photography: A method for documentation of tissue perfusion using instant photography," Current Surgery 39:310- 313.
  • Leonard, L., Munster, A. and Su, C., 1980, " Adjunctive use of intravenous fluorescein and the tangential excision of burns of the hands," Plast. Reconstr. Surg. 66 (1):30-33.
  • Marfuggi, R. and Greenspan, M., 1981, "Reliable intraoperative prediction of intestinal viability using a fluorescent indicator," Surg. Gynae. Obstet. 152:33- 35.
  • McCraw, J., Myers, B. and Shanklin, K., 1977, "The value of fluorescein in predicting the viability of arterialized flaps," Plast. Reconstr. Surg. 60(5):710-719.
  • Morris, S., Pang, C., Zhong, A. Boyd, B. and Forrest, C. 1993 "Assessment of ischaemia induced reperfusion injury in the peg latissimus dorsi myocutaneous flap model" Plast Reconstr. Surg. 92(6): 1162-1172.
  • Morykwas, M., Hills, H. and Argenta, L. 1991 "The safety of intravenous fluorescein administration" Ann. Plas. Surg. : 26: 551-553.
  • Myers, B., 1962, "Prediction of skin sloughs at the time of operation with the use of fluorescein dye," Surgery 51:158-162.
  • Perbeck, L., Proano, E. and Maattanen, H. 1991 "Skin circulation in the nipple after reduction mammaplasty with a bi-pedicle vertical dermal flap" J. Plast Reconstr Surg. 25 (1): 41-45.
  • Schaeffer, D. and Baldwin, L., 1970, "The photography of fluorescein dye fluorescence in surgery," J. Biol. Photogr. Ass. 38 (2):70-74.
  • Still, H., 1951, "Dermatological treatment of burns," Am. 0. Assoc. 50 (10):517.
  • Stolar, C. and Randolph, J., 1978, "Evaluation of ischaemic bowel viability with a fluorescent technique," J. Paed. Surg. 13 (3):221-225.
  • Welch, J., 1982, "The photography of fluorescein," Plast. Reconstr. Surg. 69(6):990-994.
  • Zuckerman, A., 1983, "Fluorescein fluorescence photography for the evaluation of burn injury," J. Biol. Photogr. 51 (2):33- 35.

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Last modified: 3 May 2002