Evaluation of the Circulation of Reconstructive Flaps Using Laser- Induced Fluorescence of Indocyanine Green

Still, Joseph M.; Law, Edward; Dawson, John T.; Bracci, Steve; Island, Tobin; Holtz, James Z.

doi:10.1097/00000637-199903000-00007

Cited by 83 publications

(66 citation statements)

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“…Most of the described systems have the major disadvantage that they are not easy to use in the human intraoperative situation. The IC-VIEW system is used in various conditions, intra-and postoperatively, to measure blood perfusion and microcirculation [29][30][31][32]. It has been proven effective and reliable in the settings of intraoperative assessment of vascular flow, evaluation of abdominal wall perfusion and intraoperative measurement of skin-flap viability [33,34].…”

Section: Discussionmentioning

confidence: 99%

Indocyanine Green Fluorescence Measurement of Intestinal Transit and Gut Perfusion after Intestinal Manipulation

Behrendt¹,

Tolba

Overhaus³

et al. 2004

Eur Surg Res

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Background and Aims: Postoperative ileus is a common and poorly understood problem of abdominal surgery. The aim of this study was to measure postoperative intestinal transit and to evaluate bowel wall perfusion by a novel in vivo indocyanine green (ICG)-fluorescence measurement following intestinal manipulation (IM). Methods: Rats underwent a simple intestinal manipulation. Myeloperoxidase-positive cells in the muscularis were stained with the Hanker-Yates reaction and quantified histochemically. Bowel wall perfusion was determined directly and 24 h postoperatively using a laser-fluorescence detection unit. Intestinal transit was visualized 24 h after IM. Results: IM resulted in a massive infiltration (155-fold) of neutrophils into the intestinal muscularis 24 h postoperatively. Bowel wall perfusion significantly decreased directly and 24 h following surgery (29 and 59%, respectively). Gastrointestinal transit was similarly impaired and showed a reduction to 40% of the control values 24 h after IM. Conclusion: IM of the rat small intestine caused an impairment in bowel wall perfusion and microcirculation and a significant decrease in gastrointestinal transit. The ICG fluorescence measurement using the described system proved to be a simple and reliable method to evaluate intestinal transit and bowel wall microcirculation in vivo.

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Section: Discussionmentioning

confidence: 99%

Indocyanine Green Fluorescence Measurement of Intestinal Transit and Gut Perfusion after Intestinal Manipulation

Behrendt¹,

Tolba

Overhaus³

et al. 2004

Eur Surg Res

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“…ICG angiography is a reliable technique in assessing tissue perfusion. However, its predictive value, data analysis and interpretation techniques are still under evaluation [7,14,16,17] . ICG angiography over-predicts venous congestion in flaps [21] .…”

Section: Discussionmentioning

confidence: 99%

“…ICG angiography has popularly become a commonly used technique to measure vascular perfusion of flaps. ICG angiography enables the surgeon to quantify perfusion throughout the flap, and patency of the pedicle [16][17][18][19] . Recent studies have shown that a perfusion cut-off can predict the likelihood of flap survival, and supplement clinical judgment for flap design and the need for trimming in both muscle and fasciocutaneous flaps [13,14,18] .…”

Section: Introductionmentioning

confidence: 99%

Is indocyanine green angiography a reliable tool for the assessment of venous congestion in muscle flaps?

Halen

Abbassi

2016

Adv Mod Oncol Res

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Indocyanine green (ICG) angiography is a useful technology for assessing flap perfusion in reconstructive procedures. Flap clearance of ICG can help in assessing venous congestion. To the best of our knowledge, although a few reports have evaluated its use for venous congestion, no reports have assessed the viability and applicability of this technology for this purpose in muscle flaps. A 63-year-old female patient with right leg leiomyosarcoma post-tumor resection underwent reconstructive surgery with a hemi-gastrocnemius flap. A scan of the flap using ICG angiography showed slow clearance of dye in the flap compared to the rest of the body. On postoperative day (POD) 1, the flap was re-examined using an infrared camera and it showed evidence of retained dye. On the contrary, there were no clinical signs of flap congestion. Ultimately, the patient had a successful reconstruction and an uncomplicated postoperative course despite the inconsistent findings in ICG angiography. ICG angiography is a useful tool in assessing arterial perfusion of flaps. However, further evaluation is needed to gain clinical reliability and validity in the evaluation of venous congestion in muscle flaps. Its overall utility with respect to pedicled muscle flaps has yet to be established.

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“…Clinical studies are rare, however, and limited to the assessment of axial and random pattern skin flaps 12 and the determination of burn depth. 13,14 To our knowledge, the use of indocyanine green 2 (ICG)-fluorescence for monitoring of free microvascular flaps has not been reported in the literature.…”

Section: à11mentioning

confidence: 99%

Monitoring free flaps using laser‐induced fluorescence of indocyanine green: A preliminary experience

et al. 2002

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In a prospective, clinical study, the clinical utility of indocyanine green for intraoperative monitoring of free tissue transfer was evaluated. The study comprised 20 surgical patients undergoing elective microsurgical procedures. Indocyanine green angiography was performed intraoperatively, immediately after flap inset, and the operating team was blind to the fluoremetric findings. Thereafter, postoperative monitoring was done exclusively by clinical examination (color, temperature, time for recapillarization, and bleeding after puncture). Final outcome was compared with results of perioperative indocyanine (ICG)-imaging, and classified either as total flap loss, partial flap loss, or successful tissue transplantation. A total of 2 (10%) complications was recorded, and included one partial and one total flap loss. Both complications were detected by intraoperative ICG imaging. Another case of intraoperative subclinical arterial spasm at the place of microvascular anastomosis was revealed by dynamic ICG-videography. This flap did not develop postoperative complications. In conclusion, evaluation of perfusion by ICG imaging is feasible in all kinds of microsurgical flaps, irrespective of the type of tissue. Even though not meeting all the criteria of an ideal monitoring device, significant additional information can be obtained. In this study, cases with arterial spasm, venous congestion, and regional hypoperfusion were revealed by intraoperative ICG-videography. There was a strong correlation between intraoperative findings and clinical outcome.

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Evaluation of the Circulation of Reconstructive Flaps Using Laser- Induced Fluorescence of Indocyanine Green

Cited by 83 publications

References 0 publications

Indocyanine Green Fluorescence Measurement of Intestinal Transit and Gut Perfusion after Intestinal Manipulation

Indocyanine Green Fluorescence Measurement of Intestinal Transit and Gut Perfusion after Intestinal Manipulation

Is indocyanine green angiography a reliable tool for the assessment of venous congestion in muscle flaps?

Monitoring free flaps using laser‐induced fluorescence of indocyanine green: A preliminary experience

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