Application of Indocyanine Green in Flap Surgery: A Systematic Review

Abstract

ICG fluorescence imaging preoperatively facilitates the detection of perforators in tissue flaps with thickness <20 mm, aids in the evaluation of flap microcirculation and perfusion, and allows surgeons to select dominant cutaneous nerves while evaluating the quality of vascular anastomoses and locating thromboses. The literature also concluded that potential allergic reactions to ICG should be taken into consideration.

The Impact of Indocyanine-Green Fluorescence Angiography on Intraoperative Decision-Making and Postoperative Outcome in Free Flap Surgery

“…In a recent review, Li et al attribute this to high procedural costs, methodological complexity, low sensitivity, and high false positive as well as false negative rates. 20 We are convinced that this is due to a lack of practicability, applicability, and reliability. However, our initial experience with ICG-NIR-VA showed promising early results.…”

“…11 In this context, we fully share the opinion of Li et al, who stated that the vascularization of the distal portions of transferred tissue represents the most critical factor in the success of reconstructive surgery. 20 Therefore, we are convinced that reliable intraoperative assessment of the perfusion of distal cutaneous free flap portions is decisive for reconstructive success. In this matter, ICG-NIR-VA can help with intraoperative decision-making regarding changes in flap design or inset.…”

Effect of Segment Length and Number of Osteotomy Sites on Cancellous Bone Perfusion in Free Fibula Flaps

“…This method is safe for patient use, can be used at the bedside or intraoperatively, and allows for multiple repeat assessments within a short period of time. 18 The usefulness of ICG angiography for soft-tissue 19 and vascular assessment 20 is undisputed. 18 Only recently, the feasibility of osseous flap perfusion assessment using ICG angiography has been demonstrated in an animal model, 16 cadavers, 17 and the clinical setting.…”

Reply to Tsukuura et al: “Novel hands‐free near‐infrared fluorescence navigation and simultaneous combined imaging for the elevation of vascularized lymph node flap”

“…As the authors stated in their communication, a near‐infrared fluorescence imaging device has been used to assist operators in a variety of surgical procedures . This technology not only can assist the surgeon during the preoperative plan, but can also be a useful adjunct in facilitating intraoperative dissection and evaluating post‐operative outcomes . Furthermore, in the last decade, near‐infrared has been used as a device to provide functional imaging of the lymphatic system .…”

“…We are aware of many companies that also offer this technological benefit, and there are several similar devices that are currently available in the market . Nevertheless, we would like to thank the authors for highlighting the usefulness and the advantages of applying innovative equipment, specifically when it comes to complex structures such as the lymphatic vessels and lymph nodes.…”