Abstract
Inadequate tissue perfusion is a key contributor to early complications following reconstructive procedures. Accurate and reliable intraoperative evaluation of tissue perfusion is critical to reduce complications and improve clinical outcomes. Clinical judgment is the most commonly used method for evaluating blood supply, but when used alone, is not always completely reliable. A variety of other methodologies have been evaluated, including Doppler devices, tissue oximetry, and fluorescein, among others. However, none have achieved widespread acceptance. Recently, intraoperative laser angiography using indocyanine green was introduced to reconstructive surgery. This vascular imaging technology provides real-time assessment of tissue perfusion that correlates with clinical outcomes and can be used to guide surgical decision making. Although this technology has been used for decades in other areas, surgeons may not be aware of its utility for perfusion assessment in reconstructive surgery. A group of experts with extensive experience with intraoperative laser angiography convened to identify key issues in perfusion assessment, review available methodologies, and produce initial recommendations for the use of this technology in reconstructive procedures.
Highlights
One of the fundamental causes of early complications following reconstructive procedures is considered to be inadequate tissue perfusion [1,2,3,4,5,6]
Technologies Inc., Richmond, British Columbia, Canada) convened a summit to develop a review describing the current state of the art of evaluation of tissue perfusion in reconstructive surgery
Of 5 patients with poor flap perfusion on indocyanine green (ICG) imaging, 4 developed necrosis and 1 blistering in a pattern predicted by ICG; necrosis rate of 6.3% vs. published rates of 15-25%
Summary
One of the fundamental causes of early complications following reconstructive procedures is considered to be inadequate tissue perfusion [1,2,3,4,5,6]. Accurate and reliable intraoperative evaluation of tissue perfusion is critical to reduce complications and improve clinical outcomes. Clinical judgment is the most widely used method for evaluating blood supply [7], but by itself is not always completely reliable for assessment of flap perfusion [8,9]. Several technologies to assess tissue vascularity have been evaluated in studies and used clinically, but none have achieved universal acceptance [6,10]. Intraoperative laser angiography using indocyanine green (ICG) is a vascular imaging methodology that can be used in the intraoperative or postoperative setting to. ICG intraoperative →Visualize perforator laser angiography* perfusion zone in real time. →Confirm perfusion of tissue prior to incision, after elevation of flaps, and prior to final closure
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