Fluorescent indocyanine green angiography: Preliminary results in microsurgery monitoring

Moris, Vivien; Cristofari, S.; Stivala, Alessio; Lehre, B.; Gengler, C.; Rabuel, V.; Srouji, A.; Zwetyenga, N.; Guilier, David

doi:10.1016/j.jormas.2019.07.006

Cited by 12 publications

(12 citation statements)

References 13 publications

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“…The Fluobeam ® system reliability has already been demonstrated in various publications for parathyroid surgery and for microsurgery flap reconstruction. 29,30 Infracyanine ® is a specialty of indocyanine green that does not contain iodine and thus reduces the risk of allergy. This association provides a better outcome for sentinel lymph node detection in our series than in other French studies.…”

Section: Discussionmentioning

confidence: 99%

“…Mean time between injection of indocyanine green and removal of the last sentinel lymph node was short, total number of excised sentinel lymph nodes per patient remained <3. The Fluobeam ® system reliability has already been demonstrated in various publications for parathyroid surgery and for microsurgery flap reconstruction 29,30 . Infracyanine ® is a specialty of indocyanine green that does not contain iodine and thus reduces the risk of allergy.…”

Section: Discussionmentioning

confidence: 99%

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Indocyanine green for sentinel lymph node detection in early breast cancer: Prospective evaluation of detection rate and toxicity—The FLUOBREAST trial

et al. 2020

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Introduction: Detection of sentinel lymph node in early breast cancer is commonly based on the combination of patent blue dye and a radioisotope 99m Technetium. Each of these two tracers has advantages and disadvantages leading to the development of the use of indocyanine green. Methods: We conducted a prospective clinical trial to compare the detection rate of indocyanine green with 99mTe. Each patient undergoing a sentinel lymph node biopsy for an early breast cancer received both indocyanine green and radioisotopes. The trial was registered: FLUOBREAST EudraCT N 2015-000698-11, ClinicalTrials. gov: NCT02875626. Results: Among a total of 88 patients, 77 were assessable for a total of 205 nodes. Detection rates were 93% for the isotope and 96% for the indocyanine green. The combined detection rate was 99%. The overall concordance rate per patient was 91%. The median number of excised sentinel nodes was 2.3 for each tracer and 2.7 for the combined method (P = .21). All the macrometastatic nodes were detected by both indocyanine green and radioisotopes. The median time between incision of the axilla and removal of the last node was 14 minutes. There was neither allergy nor radio-sensitization linked with the use of indocyanine green. Conclusions: Indocyanine green delivers a high detection rate and sensitivity for the sentinel lymph node biopsy in early breast cancer, with short operative time and a normal number of excised sentinel lymph nodes. Allergy is extremely rare and there is no toxicity. Indocyanine green could be an alternative to radioisotopes to provide an accurate staging of the axilla. Its routine use should be approved.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Indocyanine green for sentinel lymph node detection in early breast cancer: Prospective evaluation of detection rate and toxicity—The FLUOBREAST trial

et al. 2020

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“…31,38 In their study, Moris et al reported precocious salvage interventions based on the ICG outcomes including design modification of the skin paddle in fibular free flaps, stitch release, planning osteotomies in fibular and radial forearms, and even reexploration after anastomosis. 39 Moreover, ICG, owing to its high sensitivity, specificity, and positive predictive value of tissue necrosis, has been shown to increase the rate of survival of different free flaps by refining surgical decision-making on flap design. 40 Additionally, the use of ICG has shown to predict possible internal jugular vein (IJV) thrombosis intraoperatively after free flaps anastomosis by reporting greater venous flow rates and subsequent ICG fluorescence time (reaching 18 seconds) than expected.…”

Section: Icg Angiography: Results By Indication and Type Of Flap Freementioning

confidence: 99%

“…Examples of intraoperative modifications include perfusion improvement with tension stitch release, change in the pivotal point, or edge trimming. 22,39 We have used ICG angiography to evaluate lip reconstruction in three cases using a pedicled Abbe flap, as shown in ►Fig. 4.…”

Section: Pedicled Flapsmentioning

confidence: 99%

The Use of Indocyanine Green Angiography for Cosmetic and Reconstructive Assessment in the Head and Neck

2020

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Reconstructive procedures in the head and neck can be a surgical challenge owing to the complex anatomical and physiological structure. Different locoregional and microvascular flaps are used for various defects to improve both function and cosmesis. Subjective clinical findings have been the mainstay for perfusion monitoring; however, areas of borderline perfusion are much more difficult to assess clinically. Multiple technologies that offer objective perfusion assessment have been developed to improve surgical outcomes. Indocyanine green (ICG) angiography has gained popularity owing to its minimal invasiveness and increased sensitivity and specificity in assessing flap perfusion particularly in the head and neck. It has been extensively used in free flaps, pedicled flaps (including nasal reconstruction), facelift procedures, random flaps, skull base reconstruction, and pharyngocutaneous fistula prediction. Its perioperative use has provided valuable qualitative and quantitative data that aid our understanding of flap hemodynamics. Clinically, this impacted decision-making in flap design, harvest, inset, and precocious salvage interventions. Though increased cost and intraoperative time could be limitations, cost-effectiveness studies have supported its use, particularly in high-risk individuals. Limitations include the lack of standardized dosing and consistent methodology agreement for data analysis. Future studies should involve larger cohorts and multi-institute studies to overcome such limitations.

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“…This technology has been widely implemented in breast surgery, where authors highlighted the decrease in the occurrence of post-mastectomy necrosis and subsequent implant loss [2][3][4][5][6] , as it allowed to identify and remove poorly vascularised tissue. Nowadays, this technique is not as widely used in head and neck reconstructive surgery, even though there have been prior publications highlighting its benefits [7][8][9][10] . The objective of this study was to communicate our initial experience using laser-assisted angiography with ICG (LAIG) in major head and neck reconstructive procedures, describing the range of applications and report our rates of postoperative wound complications.…”

Section: Introductionmentioning

confidence: 99%

Applications of intraoperative angiography in head and neck reconstruction

Sahovaler

Gualtieri

Lee

et al. 2021

Acta Otorhinolaryngol Ital

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Objective. Laser-assisted angiography with indocyanine green (LAIG) allows objective intraoperative evaluation of tissue vascularity. We endeavored to describe our experience with this technique in the head and neck region. Methods. A retrospective review from February 2016 till October 2018 was conducted. We included patients who underwent head and neck procedures in which LAIG was employed. The main outcome was postoperative wound complications. We analysed the influence of LAIG results in intraoperative decision-making process. Results. Nineteen patients were included, and follow-up was for at least 6 months. LAIG was employed in 11 local flaps, 9 free flaps and 6 cases of pharyngeal closure during total laryngectomies. Wound complications occurred in two cases with distal tip flap necrosis. LAIG findings resulted in changes in decision making intraoperatively in 84% of procedures, which consisted in trimming poorly perfused tissues. There were no pharyngocutaneous fistulas. Conclusions. This represents a descriptive report on the use of LAIG on diverse head and neck reconstruction cases, with important impact on the decision-making process. A low number of postoperative wound complications were observed. KEY WORDS: laser-assisted angiography head and neck cancer, skin necrosis, indocyanine green, SPY RIASSUNTO Obiettivi. La tecnica LAIG (Laser-assisted angiography with indocyanine green) permette una valutazione intraoperatoria della vascolarizzazione tissutale. Con questo studio vogliamo condividere la nostra esperienza con tale tecnica nel distretto testa collo. Metodi. È stata condotta un'analisi retrospettiva che include pazienti sottoposti a chirurgia del distretto testa-collo con utilizzo di LAIG intraoperatorio. È stata valutata l'incidenza di complicanze postoperatorie della ferita chirurgica e l'influenza dell'utilizzo di LAIG intraoperatorio nel processo decisionale del chirurgo. Risultati. Diciannove pazienti sono stati inclusi con follow-up minimo di 6 mesi. LAIG è stata applicata su 11 lembi locali, 9 lembi liberi ed in 6 casi di chiusura del faringe post laringectomia totale. In due casi la necrosi distale del lembo ha portato a complicanze correlate alla ferita chirurgica. LAIG ha portato a modificazione del processo decisionale intraoperatorio nell'84% dei casi. Conclusioni. Questo studio descrittivo dimostra la applicabilità di LAIG in diverse procedure ricostruttive nel distretto testa-collo, con un impatto importante sul processo decisionale intraoperatorio ed una bassa incidenza di complicanze della ferita chirurgica.

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Fluorescent indocyanine green angiography: Preliminary results in microsurgery monitoring

Cited by 12 publications

References 13 publications

Indocyanine green for sentinel lymph node detection in early breast cancer: Prospective evaluation of detection rate and toxicity—The FLUOBREAST trial

Indocyanine green for sentinel lymph node detection in early breast cancer: Prospective evaluation of detection rate and toxicity—The FLUOBREAST trial

The Use of Indocyanine Green Angiography for Cosmetic and Reconstructive Assessment in the Head and Neck

Applications of intraoperative angiography in head and neck reconstruction

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