Intraoperative evaluation of skin-flap viability using laser-induced fluorescence of indocyanine green

Holm, Charlotte; Mayr, Martina; Höfter, Eugen; Becker, Andreas; Pfeiffer, U.J.; Mühlbauer, W.

doi:10.1054/bjps.2002.3969

Cited by 189 publications

(169 citation statements)

References 9 publications

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“…2 While some research groups have investigated its use as a far-red fluorophore, 29 the low fluorescence yield and lack of any functional groups for addition of ligands have limited its use in clinical applications. ICG is the only approved fluorophore in the NIR-window and several imagers have been designed and commercially launched to allow ICG guidance in surgery for blood flow assessment, [30][31][32] hepatic function assessment, 33,34 and vessel patency and perfusion evaluation especially in reconstructive 35,36 and bypass surgeries. 37,38 The low tissue autofluorescence in the NIR-wavelengths further simplifies the task of filtering out background signals, and since ICG is the primary reimbursable agent today, almost all imaging device companies have built systems specifically for ICG imaging.…”

Section: Introductionmentioning

confidence: 99%

Review of fluorescence guided surgery systems: identification of key performance capabilities beyond indocyanine green imaging

et al. 2016

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Abstract. There is growing interest in using fluorescence imaging instruments to guide surgery, and the leading options for open-field imaging are reviewed here. While the clinical fluorescence-guided surgery (FGS) field has been focused predominantly on indocyanine green (ICG) imaging, there is accelerated development of more specific molecular tracers. These agents should help advance new indications for which FGS presents a paradigm shift in how molecular information is provided for resection decisions. There has been a steady growth in commercially marketed FGS systems, each with their own differentiated performance characteristics and specifications. A set of desirable criteria is presented to guide the evaluation of instruments, including: (i) real-time overlay of white-light and fluorescence images, (ii) operation within ambient room lighting, (iii) nanomolar-level sensitivity, (iv) quantitative capabilities, (v) simultaneous multiple fluorophore imaging, and (vi) ergonomic utility for open surgery. In this review, United States Food and Drug Administration 510(k) cleared commercial systems and some leading premarket FGS research systems were evaluated to illustrate the continual increase in this performance feature base. Generally, the systems designed for ICG-only imaging have sufficient sensitivity to ICG, but a fraction of the other desired features listed above, with both lower sensitivity and dynamic range. In comparison, the emerging research systems targeted for use with molecular agents have unique capabilities that will be essential for successful clinical imaging studies with low-concentration agents or where superior rejection of ambient light is needed. There is no perfect imaging system, but the feature differences among them are important differentiators in their utility, as outlined in the data and tables here. © The Authors. Published by SPIE under a Creative Commons Attribution 3.0 Unported License. Distribution or reproduction of this work in whole or in part requires full attribution of the original publication, including its DOI.

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Section: Introductionmentioning

confidence: 99%

Review of fluorescence guided surgery systems: identification of key performance capabilities beyond indocyanine green imaging

et al. 2016

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“…This and the physiological limitations of fluorescein dye, which make it inferior to ICG, a second‐generation dye, may explain why it has not been adopted widely for use in the plastic and reconstructive setting for assessment of mastectomy skin flaps53.…”

Section: Discussionmentioning

confidence: 99%

Systematic review of methodologies used to assess mastectomy flap viability

et al. 2018

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BackgroundAccurate prediction of mastectomy skin flap viability is vital as necrosis causes significant morbidity, potentially compromising results and delaying oncological management. Traditionally assessed by clinical judgement, a more objective evaluation can be provided using intraoperative imaging modalities. This systematic review aimed to compare all intraoperative techniques for assessment of mastectomy flap viability.MethodsA systematic literature review was performed using MEDLINE and Embase databases. Primary outcomes reported included specificity, sensitivity and predictive values of each test, and mean rates of mastectomy flap necrosis and reoperation. Secondary outcomes included cost analysis.ResultsSome 18 studies were included. Designs were prospective cohort study (8), retrospective case series (4), prospective case series (3), retrospective case–control study (1), prospective pilot trial (1) and cost analysis study (1). The studies compared indocyanine green angiography (ICGA) (16 studies) and fluorescein dye angiography (FA) (3 studies) with clinical judgement. Sensitivity and specificity were highest for ICGA (5 studies) ranging from 38 to 100 and 68 to 91 per cent respectively. Both methods overpredicted necrosis. Mean rates of flap necrosis and reoperation decreased with ICGA (7·9 and 5·5 per cent respectively) and FA (3 and 0 per cent) compared with clinical judgement (19·4 and 12·9 per cent). Two studies were designed to define numerical parameters corresponding to perfusion using intraoperative techniques. Two studies performed a cost analysis for ICGA; one claimed a cost benefit and the other advocated its use in high‐risk patients only.ConclusionICGA and FA are potentially useful tools for mastectomy flap assessment. However, the predictive accuracy is subject to the specific settings and model of equipment used. Current recommendations support their use in high‐risk patients.

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“…Indocyanine (ICG) fluorescence method is a widely used infrared optical imaging technique superior to fluorescein angiography [74] which has been used to monitor blood flow in various clinical imaging applications. The ICG dye is intravenously introduced to the patient and upon accumulation in the location of interest, it is laser excited and the resulting fluorescence is detected by a CCD camera.…”

Section: Clinical Implications Of Blood Flow Assessmentsmentioning

confidence: 99%

“…The ICG dye is intravenously introduced to the patient and upon accumulation in the location of interest, it is laser excited and the resulting fluorescence is detected by a CCD camera. ICG fluorescence analysis has been employed in numerous environments for example in the assessment of burn depth [75]; intraoperative skin flap viability [74] and the patency of coronary artery bypass grafts [76]; the feasibility of detection of exogenous chromophores in the adult human brain has been demonstrated; and ICG contrast agents have been used in various oncological studies, i.e. the detection of carcinogenic cells with a sensitivity of 1 : 10 7 in the background of normal cells [77] and in the analysis of lymph flow in breast cancer patients [78].…”

Section: Clinical Implications Of Blood Flow Assessmentsmentioning

confidence: 99%

‘Go with the flow ’: A review of methods and advancements in blood flow imaging

Daly

Leahy

2012

Journal of Biophotonics

105

108

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Physics has delivered extraordinary developments in almost every facet of modern life. From the humble thermometer and stethoscope to X‐Ray, CT, MRI, ultrasound, PET and radiotherapy, our health has been transformed by these advances yielding both morphological and functional metrics. Recently high resolution label‐free imaging of the microcirculation at clinically relevant depths has become available in the research domain. In this paper, we present a comprehensive review on current imaging techniques, state‐of‐the‐art advancements and applications, and general perspectives on the prospects for these modalities in the clinical realm. (© 2013 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)

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Intraoperative evaluation of skin-flap viability using laser-induced fluorescence of indocyanine green

Cited by 189 publications

References 9 publications

Review of fluorescence guided surgery systems: identification of key performance capabilities beyond indocyanine green imaging

Review of fluorescence guided surgery systems: identification of key performance capabilities beyond indocyanine green imaging

Systematic review of methodologies used to assess mastectomy flap viability

‘Go with the flow ’: A review of methods and advancements in blood flow imaging

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