Quantification of near-infrared fluorescence imaging with indocyanine green in free flap breast reconstruction

Hoven, Pim van den; Verduijn, Pieter S.; Capelle, L.; Tange, Floris P; Michi, Marlies; Corion, LUM; Mulder, B. Sibinga; Mureau, Marc A.M.; Vahrmeijer, A.L.; Vorst, Joost R. van der

doi:10.1016/j.bjps.2021.12.004

Cited by 13 publications

(12 citation statements)

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“…The SPY Elite System and the analytic software SPY‐Q were the most popular system used (55%) among included studies. The emitting wavelength of the laser beam was 760–806 nm in the studies (Holm et al, 2006; Lee et al, 2010; Newman & Samson, 2009; van den Hoven et al, 2022). The camera was perpendicular to the surface of the region of interest (ROI) at a distance of approximately 12–19 inches (Anker et al, 2020; Lee et al, 2010; Newman & Samson, 2009; van den Hoven et al, 2022).…”

Section: Resultsmentioning

confidence: 99%

“…The emitting wavelength of the laser beam was 760–806 nm in the studies (Holm et al, 2006; Lee et al, 2010; Newman & Samson, 2009; van den Hoven et al, 2022). The camera was perpendicular to the surface of the region of interest (ROI) at a distance of approximately 12–19 inches (Anker et al, 2020; Lee et al, 2010; Newman & Samson, 2009; van den Hoven et al, 2022). Approximately 2.5–15 mg ICG dye was administered as a bolus intravenously, followed by a bolus of saline flush.…”

Section: Resultsmentioning

confidence: 99%

“…Three forms of data were identified to assess perfusion and vascular patency. They were absolute (Girard et al, 2019; Losken et al, 2012; Munabi et al, 2014; van den Hoven et al, 2022) and relative value (Anker et al, 2020; Holm et al, 2006; Lee et al, 2010; Ludolph et al, 2016; Ludolph et al, 2022) for fluorescent intensity and time‐relevant parameters, such as injection‐filling time interval (Holm et al, 2006), and intensity‐time curves (Yoo et al, 2022). Qualitative assessment of fluorescent intensity based on the intraoperative judgment of surgeons was also mentioned in many studies.…”

Section: Resultsmentioning

confidence: 99%

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Flap perfusion assessment with indocyanine green angiography in deep inferior epigastric perforator flap breast reconstruction: A systematic review and meta‐analysis

et al. 2023

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BackgroundIndocyanine green angiography (ICG‐A) has been widely applied for intraoperative flap assessment in DIEP flap breast reconstruction. However, the beneficial effect of ICG‐A in DIEP flap breast reconstruction is still uncertain and no standardized protocol is available. This study aims to analyze the clinical outcome and comprehensively review protocols of this field.MethodsA systematic review was conducted in MEDLINE, EMBASE, and Cochrane CENTRAL databases until September 15, 2022. Studies on the utility of intraoperative ICG‐A in DIEP breast reconstruction were included. Data reporting reconstruction outcomes were extracted for pooled analysis.ResultsA total of 22 studies were enrolled in the review, among five studies with 1021 patients included in the meta‐analysis. The protocols of ICG‐A assessment of DIEP flap varied among studies. According to the pooled results, the incidence of postoperative fat necrosis was 10.89% (50 of 459 patients) with ICG‐A and 21.53% (121 of 562 patients) with clinical judgment. The risk for postoperative fat necrosis was significantly lower in patients with intraoperative ICG‐A than without (RR 0.47 95% CI 0.29–0.78, p = .004, I2 = 51%). Reoperation occurred in 5 of 48 patients (10.42%) in the ICG‐A group and in 21 of 64 patients (32.82%) in the control group summarized from reports in two studies. The risk for reoperation was lower in the ICG‐A group than in the control group (RR 0.41 95% CI 0.18–0.93, p = .03, I2 = 0%). Other complications, including flap loss, seroma, hematoma, dehiscence, mastectomy skin necrosis, and infection, were comparable between the two groups. Heterogeneities among studies were acceptable. No significant influence of specific studies was identified in sensitivity analysis.ConclusionsICG‐A is an accurate and reliable way to identify problematic perfusion of DIEP flaps during breast reconstruction. Protocols of ICG‐A differed in current studies. Intraoperative ICG‐A significantly decreases the rate of fat necrosis and reoperation in patients undergoing DIEP breast reconstruction. The synthesized results should be interpreted sensibly due to the sample size limitation. RCTs on the outcomes and high‐quality studies for an optimized ICG‐A protocol are still needed in the future.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Flap perfusion assessment with indocyanine green angiography in deep inferior epigastric perforator flap breast reconstruction: A systematic review and meta‐analysis

et al. 2023

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“…Огляди трастного забарвлення здорової тканини і можливість радіометричної дискримінації [18,19]. Зазначимо, що більшість із наведених систем мають змогу отримати зображення у ближньому інфрачервоному діапазоні близько 800 нм, що є довжиною хвилі збудження ICG [1,2,3,15].…”

Section: A 1bunclassified

Intraoperative near-infrared fluorescence visualization of anatomical structures in general surgical and urological practice

Chaika,

Ilyina-Stognienko,

Ochigava

2024

Zaporozhye Medical Journal

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Aim: to analyze current literature on the assessment of intraoperative near-infrared fluorescence visualization of anatomical structures in general surgical and urological practice. The experience of using intraoperative near-infrared fluorescence visualization of anatomical structures in general surgical and urological practice is analyzed. The priority areas of the method application are defined, the recent clinical studies in various fields of surgery and urology are reviewed. Conclusions. The method of intraoperative near-infrared fluorescence imaging of anatomical structures with abundant vascularization and for assessing oncological prognosis is the most promising.

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“…One of the most promising recently developed techniques is indocyanine green (ICG) near-infrared fluorescence (NIRF), which is currently increasingly being applied across all surgical fields [1][2][3][4]. ICG-NIRF has gained recognition as a reliable real-time technique for visualizing tissue perfusion, e.g., enabling the precise placement of anastomoses and Life 2024, 14, 186 2 of 18 the identification of potential vascular compromise, potentially reducing perfusion-related complications [5,6].…”

Section: Introductionmentioning

confidence: 99%

Optimizing Indocyanine Green Dosage for Near-Infrared Fluorescence Perfusion Assessment in Bowel Anastomosis: A Prospective, Systematic Dose-Ranging Study

Lobbes,

Schier,

Tiebie

et al. 2024

Life

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Background: Indocyanine green (ICG) near-infrared fluorescence (NIRF) has emerged as a promising technique for visualizing tissue perfusion. However, within the wide range of dosages and imaging conditions currently being applied, the optimal dosage of ICG remains unclear. This study aimed to investigate the feasibility and implications of implementing lower dosages of ICG than commonly used for visual and quantitative perfusion assessment in a standardized setting. Methods: A prospective single-center cohort study was conducted on patients undergoing ileostomy reversal by hand-sewn anastomosis. ICG-NIRF visualization was performed before (T1) and after (T2) anastomosis with one of four different dosages of ICG (5 mg, 2.5 mg, 1.25 mg, or 0.625 mg) and recorded. Postoperatively, each visualization was evaluated for signal strength, completeness, and homogeneity of fluorescence. Additionally, perfusion graphs were generated by a software-based quantitative perfusion assessment, allowing an analysis of perfusion parameters. Statistical analysis comparing the effect of the investigated dosages on these parameters was performed. Results: In total, 40 patients were investigated. Visual evaluation demonstrated strong, complete, and homogeneous fluorescence signals across all dosages. Perfusion graph assessment revealed a consistent shape for all dosages (ingress followed by egress phase). While the average signal intensity decreased with dosage, it was sufficient to enable perfusion assessment even at the lowest dosages of 1.25 mg and 0.625 mg of ICG. The baseline intensity at T2 (the second intraoperative visualization) significantly decreased with dosage. The slope of the egress phase steepened with decreasing dosage. Conclusions: Lower dosages of ICG were sufficient for intraoperative perfusion assessment, while causing lower residual fluorescence and quicker egress in subsequent visualizations.

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Quantification of near-infrared fluorescence imaging with indocyanine green in free flap breast reconstruction

Cited by 13 publications

References 21 publications

Flap perfusion assessment with indocyanine green angiography in deep inferior epigastric perforator flap breast reconstruction: A systematic review and meta‐analysis

Flap perfusion assessment with indocyanine green angiography in deep inferior epigastric perforator flap breast reconstruction: A systematic review and meta‐analysis

Intraoperative near-infrared fluorescence visualization of anatomical structures in general surgical and urological practice

Optimizing Indocyanine Green Dosage for Near-Infrared Fluorescence Perfusion Assessment in Bowel Anastomosis: A Prospective, Systematic Dose-Ranging Study

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