Clinical Applications of ICG Fluorescence Imaging in Plastic and Reconstructive Surgery~!2009-12-01~!2009-12-23~!2010-05-26~!

Abstract

Aims and Background: Compromise in blood supply and failure in tissue transfer are associated with excessive resource costs in plastic surgery. The ability to detect impaired blood supply on the table would contribute to major cost savings for the health care system. Indocyanine green imaging (ICGA) holds promise as a simple method with a high sensitivity and specificity for assessing blood flow in the operating room. Methods: In this review, experimental and clinical studies concerning the use of ICGA in the field of plastic and reconstructive surgery are reviewed. Findings: Possible plastic surgical applications of ICGA range from assessment of flap perfusion in pedicle and free flap surgery to patency assessment of microvascular anastomoses, sentinel node detection, lymph vessel identification, and burn depth estimation. Conclusions: At present ICGA offers the best data-supported estimates of blood supply in reconstructive plastic surgery. Substantial evidence exists that intraoperative ICGA improves the quality of plastic surgical procedures and has the potential to reduce peri-and postoperative morbidity significantly.

PEG-Like Nanoprobes: Multimodal, Pharmacokinetically and Optically Tunable Nanomaterials

“…Thus PN(783)4.3, which had a of 1.74 h −1 in mice ( Figure 4C ), which can be expressed as a half-life of 23.7 minutes, might be satisfactory as a “long” circulating fluorochrome for intraoperative angiography in humans. ICG, with a blood half-life of 2.5–3 minutes (manufacturer’s package insert) in humans, is currently used for intraoperative fluorescent angiography in neurosurgery [22] or reconstructive surgery [23] , [24] .…”

Emerging Fluorescent Molecular Tracers to Guide Intra-Operative Surgical Decision-Making

“…Clinically-approved applications of ICG are determining cardiac output and hepatic function, and ophthalmic angiography (Soons et al, 1991; Iijima et al, 1997; Stanga et al, 2003). A broader range of applications has since been investigated, going from the use of ICG in reconstructive surgery for assessment of tissue perfusion (Holm, 2010), to sentinel lymph node mapping (Aoun et al, 2017; Chand et al, 2018), ureter visualization (Siddighi et al, 2014), and in some cases, tumor imaging (Van Der Vorst et al, 2013; Liberale et al, 2017; Nakaseko et al, 2018). ICG tumor uptake is reliant on the enhanced permeability and retention (EPR) effect, which, while effective in mouse models, has seen only limited applicability in the human situation due to differences in tumor growth and development (Nichols and Bae, 2014; Danhier, 2016), and has been demonstrated to lead to false-positive results for image-guided surgery (Tummers et al, 2015).…”