Laser-induced fluorescence of indocyanine green: plastic surgical applications

Abstract

The objective assessment of tissue perfusion is of utmost importance to plastic surgeons. Nevertheless, clinical observation remains the accepted gold standard for assessment of microcirculation. Dynamic laser fluorescence videography is a new technique for objective assessment of blood flow. We describe our clinical experience using this technique in plastic surgical patients. Possible implementations include evaluation of pedicle (random and axial pattern) flaps, monitoring of free tissue transfer and replants, and the objective determination of burn depth. Compared with standard clinical assessment techniques indocyanine green imaging provides significant additional information which allows a rational and evidence-based planning of surgery.

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

“…However, most of these method have not found widespread acceptance, probably due to a lack of convincing evidence of efficacy [12]. At present ICG video angiography offers the best data-supported estimates of blood supply in random pattern and axial flap surgery [13][14][15][16]. ICGA is unique in that it offers a dynamic map of dermal circulation, providing a detailed topographical analysis of the effective blood supply to the flap tissue ( Fig.…”

“…1). Differences in perfusion between normal and flap skin yields a "perfusion index", which in several studies has been shown to be indicative of postoperative complications [13][14][15][16]. Differentiation between arterial and venous vascular compromise is possible based on fluorescence intensities and clearance characteristics when compared to the surrounding skin.…”

“…Even though in experimental studies, a perfusion index threshold value of 25% has been demonstrated [18,19]. clinical findings are less consistent [14,15,20]. This is probably due to the fact that the ICGA measurement represents a snap-shot of the tissue perfusion to a given point of time.…”

Evaluation of Intranasal Flap Perfusion by Intraoperative Indocyanine Green Fluorescence Angiography

“…Indocyanine green (ICG) near-infrared imaging has been utilized in neurosurgery for intraoperative angiography as well as plastic surgery for understanding tissue viability. [9][10][11][12][13][14][15] Plastic surgeons have shown utility in predicting postoperative flap necrosis for local advancement flaps, pedicled flaps, and free-flap tissue transfers. [9][10][11][12][13][14][15][16][17] ICG has also been used to understand pedicled flap perfusion in the head and neck region.…”

“…[9][10][11][12][13][14][15] Plastic surgeons have shown utility in predicting postoperative flap necrosis for local advancement flaps, pedicled flaps, and free-flap tissue transfers. [9][10][11][12][13][14][15][16][17] ICG has also been used to understand pedicled flap perfusion in the head and neck region. [18][19][20] The objective of our pilot study was to evaluate the efficacy of ICG near-infrared endoscopy in predicting the viability of local, pedicled intranasal flaps during endoscopic endonasal surgery (EES) of the skull base.…”