Detection of Skin Perforators by Indocyanine Green Fluorescence Nearly Infrared Angiography

Azuma, Ryuichi; Morimoto, Yuji; Masumoto, Kazuma; Nambu, Mitsuhiro; Takikawa, Megumi; Yanagibayashi, Satoshi; Yamamoto, Naoto; Kikuchi, Makoto; Kiyosawa, Tomoharu

doi:10.1097/prs.0b013e3181858bd2

Cited by 77 publications

(63 citation statements)

References 22 publications

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“…[28] demonstrated that ICG-FA precisely identified the perforators in each patient and also provided information on the direction of blood flow. The blood supply to the abdominal wall is derived from perforators of the superior epigastric and deep inferior epigastric arteries [6], which may be of importance to identify with ICG-FA intraoperatively as it has been proposed to be possibly disrupted during the extensive undermining and elevation of skin flaps during components separation technique in complex VHR [30], although this remains to be substantiated.…”

Section: Discussionmentioning

confidence: 97%

“…Over the last decade, ICG-FA has been applied to numerous fields of surgery including cardiovascular intraoperative graft evaluation [17,18], solid organ transplant graft perfusion [19,20], and ophthalmologic evaluation of chorioretinal disorders [21]. It has been suggested to be beneficial in the intraoperative evaluation of skin and soft tissue reconstruction, particularly in breast reconstruction, with the ability to evaluate tissue perfusion, detect skin perforators, predict skin flap necrosis and loss, and prevent complications of wound healing [22][23][24][25][26][27][28][29].…”

Section: Introductionmentioning

confidence: 99%

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Intraoperative indocyanine green fluorescence angiography to predict wound complications in complex ventral hernia repair

Colavita

Wormer

Belyansky

et al. 2015

Hernia

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Intraoperative indocyanine green fluorescence angiography to predict wound complications in complex ventral hernia repair

Colavita

Wormer

Belyansky

et al. 2015

Hernia

View full text Add to dashboard Cite

show abstract

“…To solve these problems, an indocyanine green (ICG) fluorescence imaging system was developed and used by Kitai et al for sentinel lymph node mapping in patients with breast cancer [31]. Since lymph and blood flow can be observed in real time during surgery using ICG fluorescence imaging, the use of this approach has expanded to sentinel lymph node mapping in patients with breast cancer [32] and digestive organ cancer [34], [35], evaluation of lymph channels in patients with lymphedema [35], evaluation of graft vessels [36] in coronary bypass surgery, and blood flow evaluation in reconstructed organs such as free flaps [37], [38]. Thus, this angiographic technique is used widely.…”

Section: Introductionmentioning

confidence: 99%

Indocyanine Green Fluorescence Imaging for Evaluation of Uterine Blood Flow in Cynomolgus Macaque

et al. 2012

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BackgroundUterine blood flow is an important factor in uterine viability, but the number of blood vessels required to maintain viability is uncertain. In this study, indocyanine green (ICG) fluorescence imaging was used to examine uterine hemodynamics and vessels associated with uterine blood flow in cynomolgus macaque.MethodsThe uterus of a female cynomolgus macaque was cut from the vaginal canal to mimic a situation during trachelectomy or uterine transplantation surgery in which uterine perfusion is maintained only with uterine and ovarian vessels. Intraoperative uterine hemodynamics was observed using ICG fluorescence imaging under conditions in which various nutrient vessels were selected by clamping of blood vessels. A time-intensity curve was plotted using imaging analysis software to measure the Tmax of uterine perfusion for selected blood vessel patterns. Open surgery was performed with the uterus receiving nutritional support only from uterine vessels on one side. The size of the uterus after surgery was monitored using transabdominal ultrasonography.ResultsThe resulting time-intensity curves displayed the average intensity in the regions of the uterine corpus and uterine cervix, and in the entire uterus. Analyses of the uterine hemodynamics in the cynomolgus macaque showed that uterine vessels were significantly related to uterine perfusion (P = 0.008), whereas ovarian vessels did not have a significant relationship (P = 0.588). When uterine vessels were clamped, ovarian vessels prolonged the time needed to reach perfusion maximum. Postoperative transabdominal ultrasonography showed that the size of the uterus was not changed 2 months after surgery, with recovery of periodic menstruation. The cynomolgus macaque has got pregnant with favorable fetus well-being.ConclusionUterine vessels may be responsible for uterine blood flow, and even one uterine vessel may be sufficient to maintain uterine viability in cynomolgus macaque. Our results show that ICG fluorescence imaging is useful for evaluation of uterine blood flow since this method allows real-time observation of uterine hemodynamics.

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“…Studies in reconstructive surgical procedures have reported good correlation between ICG-visualized circulation and postoperative outcomes [13,23,64-66]. In case series and prospective studies, adequate intraoperative perfusion assessment using SPY was associated with reduced rates of postoperative necrosis and flap loss compared to clinical judgment alone in a variety of reconstructive procedures, including free flap, pedicle flap, and implant reconstructions [1,5,8,11,14,18,20-22,67]. …”

Section: Introductionmentioning

confidence: 99%

Intraoperative laser angiography using the SPY system: review of the literature and recommendations for use

et al. 2013

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Inadequate tissue perfusion is a key contributor to early complications following reconstructive procedures. Accurate and reliable intraoperative evaluation of tissue perfusion is critical to reduce complications and improve clinical outcomes. Clinical judgment is the most commonly used method for evaluating blood supply, but when used alone, is not always completely reliable. A variety of other methodologies have been evaluated, including Doppler devices, tissue oximetry, and fluorescein, among others. However, none have achieved widespread acceptance. Recently, intraoperative laser angiography using indocyanine green was introduced to reconstructive surgery. This vascular imaging technology provides real-time assessment of tissue perfusion that correlates with clinical outcomes and can be used to guide surgical decision making. Although this technology has been used for decades in other areas, surgeons may not be aware of its utility for perfusion assessment in reconstructive surgery. A group of experts with extensive experience with intraoperative laser angiography convened to identify key issues in perfusion assessment, review available methodologies, and produce initial recommendations for the use of this technology in reconstructive procedures.

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Detection of Skin Perforators by Indocyanine Green Fluorescence Nearly Infrared Angiography

Cited by 77 publications

References 22 publications

Intraoperative indocyanine green fluorescence angiography to predict wound complications in complex ventral hernia repair

Intraoperative indocyanine green fluorescence angiography to predict wound complications in complex ventral hernia repair

Indocyanine Green Fluorescence Imaging for Evaluation of Uterine Blood Flow in Cynomolgus Macaque

Intraoperative laser angiography using the SPY system: review of the literature and recommendations for use

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