Indocyanine Green Fluorescent Dye Research Articles

Utility of indocyanine green fluorescent dye in emergency general surgery: a review of the contemporary literature.

For decades, indocyanine green (ICG) has been available for medical and surgical use. The indications for ICG use in surgery have expanded where guided surgery directed by fluorescence and near-infrared fluorescent imaging offers numerous advantages. Recently, surgeons have reported using ICG operative navigation in the emergency setting, with fluorescent cholangiography being the most common procedure. The utility of ICG also involves real-time perfusion assessment, such as ischemic organs and limbs. The rising use of ICG in surgery can be explained by the ICG's rapid technological evolution, accuracy, ease of use, and great potential to guide precision surgical diagnosis and management. The review aims to summarize the current literature on the uses of ICG in emergency general surgery. It provides a comprehensive and practical summary of the use of ICG, including indication, route of administration, and dosages. To simplify the application of ICG, we subdivided its use into anatomical mapping and perfusion assessment. Anatomical mapping includes the biliary tree, ureters, and bowel. Perfusion assessment includes bowel, pancreas, skin and soft tissue, and gonads. This review provides a reference to emergency general surgeons to aid in implementing ICG in the emergency setting for more enhanced and safer patient care.

Nanoencapsulation of green tea catechin (−)-Epigallocatechin-3- Gallate (EGCG) in niosomes and assessment of its anticancer activity against lung cancer

Lung cancer is one of the leading causes of cancer-related deaths worldwide. In chemotherapy, the use of strong cytotoxic drugs and the specificity problems of these drugs also affect healthy cells and tissues. For this reason, the purpose of cancer treatment is to ensure that a suitable drug directly affects cancer cells at the appropriate dose. With nanotechnology, steps have been taken for an effective treatment that develops nano-transporters to deliver the drug molecule to the target cell in a specific, controlled manner. Another development is the discovery of theranostic agents used for both diagnostic and therapeutic purposes. In this study, a smart molecule was developed using the anticancer and antioxidant Epigallocatechin-3-Gallate (EGCG) molecule found in green tea, which is commonly consumed in our society. This molecule was encapsulated with niosomes to increase its stability and specificity. In this study, niosomes with an average size of 150 nm were synthesized using the thin film hydration technique. The zeta potential value of niosomes varied between −25 mV and −30 mV. Niosomes have been functionalized with indocyanine green (ICG) fluorescent dye and made suitable for optical imaging. The encapsulation efficiencies of the EGCG molecule and the ICG fluorescent dye were 10.1 % and 34.4 %, respectively. The release of EGCG from niosomes was an initial fast and then a slower release. 32 % of EGCG was released from niosomes within the first 3 h. Also, Cetuximab molecule was conjugated to niosomes with 75.8 % efficiency in order to provide lung cancer specificity and increase the anticancer effect. DLS, FTIR, XPS and TEM were used in the characterization phase of nanoparticles. While DLS and TEM provide information about dimensional analysis, FTIR and XPS were performed to verify the conjugations. Cytotoxicity, apoptosis, fluorescence imaging and incorporation studies of the molecule design created for theranostic purposes in A549 lung carcinoma and BEAS-2B normal bronchial epithelial cells were examined in vitro. As a result of these studies, it was determined that the synthesized molecule design has more involvement, toxic and apoptotic effects on A549 lung carcinoma cells. In this study, the therapeutic efficacy of the synthesized niosomal molecule design on the target cell and its potential to be used in cancer treatment were revealed and it is thought that it will contribute to the field of biotechnology.

ПРИМЕНЕНИЕ ФЛУОРЕСЦЕНТНОГО КРАСИТЕЛЯ ИНДОЦИАНИНА ЗЕЛЕНОГО В ТЕРАНОСТИКЕ ОНКОЛОГИЧЕСКИХ ЗАБОЛЕВАНИЙ (обзор литературы)

In modern medicine, the fluorescent dye indocyanine green (ICG) is used in the diagnosis and treatment of many diseases, including malignant neoplasms. The use of ICG is primarily due to such positive properties of the drug as chemical resistance and photostability, unique traceability and high lymphotropicity. The ICG preparation, as a fluorescent contrast agent, is used in the diagnosis of many diseases, in particular to determine the fraction of cardiac output, the function of blood flow of parenchymal organs (liver, spleen) and in ophthalmology, to assess the blood supply of intestinal anastomoses and in angiography. ICG is used in oncology in the surgical treatment of tumors. The fluorescent image under the control of infrared radiation makes it possible to identify the structures to be removed (tumor tissue, lymph nodes). The role of the fluorescent dye ICG in the mapping of signaling lymph nodes in oncology is high. The technique is highly informative in identifying lymph nodes involved in the tumor process, to determine the stage of the tumor, prediction and selection of antitumor therapy. In addition, ICG is used in photodynamic and photothermal therapy of tumors. Due to its photosensitizing properties, ICG is used to generate forms of oxygen or heat in order to destroy tumor cells.

Sentinel lymph node mapping in endometrial cancer: A comparison of main national and international guidelines.

To compare national and international guidelines regarding sentinel lymph node (SLN) mapping in endometrial cancer. A descriptive comparative study of the National Comprehensive Cancer Network (NCCN), the Society of Gynecologic Oncology (SGO), the European Society of Gynecological Oncology (ESGO), the British Gynecological Cancer Society (BGCS), and the Japan Society of Gynecologic Oncology (JSGO) guidelines. There is a broad consensus that SLN mapping is an appropriate alternative to pelvic lymphadenectomy for uterine-confined endometrioid endometrial cancer (five of five guidelines). It is broadly accepted that a full lymphadenectomy should be performed in case of failed SLN mapping (four of five guidelines), and that mapping with the fluorescent dye indocyanine green is superior to other methods (four of five guidelines). It is agreed that the cervix is the preferable site for dye injection (four of five guidelines), and pathology ultrastaging is advocated by most guidelines (three of five guidelines). Regarding high-risk patients (i.e., high-grade histology and non-endometroid carcinomas), some guidelines accept (three of five), but others currently do not advocate (one of five guidelines), SLN mapping as a sole method for lymph node evaluation. There is no consensus regarding para-aortic lymph node evaluation in pelvic SLN-positive patients. Guidelines for SLN mapping are comparable with regards to surgical technique, ultrastaging, and management in case of failed mapping. Nevertheless, some variations exist regarding the management of high-grade histology and positive pelvic lymph nodes.

The oncologic safety and accuracy of indocyanine green fluorescent dye marking in securing the proximal resection margin during totally laparoscopic distal gastrectomy for gastric cancer: a retrospective comparative study

BackgroundSecuring the proximal resection margin in totally laparoscopic distal gastrectomy for gastric cancer is related to curability and recurrence, while reducing the operation time is related to patient safety. This study aimed to investigate the role of indocyanine green (ICG) fluorescent dye marking in totally laparoscopic distal gastrectomy, whether it is an oncologically safe and accurate procedure that can be conducted in a single centre.MethodsThe data of 93 patients who underwent laparoscopic-assisted distal gastrectomy (non-ICG group) or totally laparoscopic distal gastrectomy using ICG (ICG group) between 2010 and 2020 were retrospectively reviewed. To correct for confounding factors, a propensity score matching was performed.ResultsProximal resection margin did not vary with the ICG injection site after the propensity score matching (lower ICG, 3.84 cm vs. lower non-ICG, 4.42 cm, p = 0.581; middle ICG, 3.34 cm vs. middle non-ICG, 3.20 cm; p = 0.917), while the operation time was reduced by a mean of 34 min in the ICG group (ICG, 239.3 [95% confidence interval, 220.1–258.5 min]; non-ICG, 273.0 [95% confidence interval, 261.6–284.4] min; p = 0.006).ConclusionsICG injection for securing the proximal resection margin in totally laparoscopic distal gastrectomy is an oncologically safe and accurate procedure, with the advantage of reducing the operation time of gastric cancer surgery while it has the benefit of locating the tumour or clips when it is impossible to locate the tumour during surgery due to the inability to perform an endoscopic examination or when it is hard to directly palpate the tumour or clips in the operating theatre; this can be performed at a single centre.

Using Alendronic Acid Coupled Fluorescently Labelled SM Liposomes as a Vehicle for Bone Targeting.

We recently developed a liposomal nanoparticle system that can be used for drug delivery and simultaneously be monitored by optical or photoacoustic imaging devices. Here we tested the efficacy of alendronate as a homing molecule in SM-liposomes for bone targeting. Alendronate was immobilized covalently on the liposomal surface and the fluorescent dye indocyanine green was used as a payload in the liposomes. The indocyanine green delivery was analyzed by 3D optical tomography, optical fluorescence scanner, photoacoustic imaging, and by ex-vivo biodistribution studies. The results show that the alendronate, coupled to the liposomal surface, increases sphingomyelin containing liposome targeting up to several-folds. The alendronate targeted liposomes open possibilities for an application in active bone targeting.

Indocyanine green labeling for optical and photoacoustic imaging of mesenchymal stem cells after in vivo transplantation.

The transplantation of mesenchymal stem cells (MSCs) holds great promise for the treatment of a plethora of human diseases, but new noninvasive procedures are needed to monitor the cell fate in vivo. Already largely used in medical diagnostics, the fluorescent dye indocyanine green (ICG) is an established dye to track limited numbers of cells by optical imaging (OI), but it can also be visualized by photoacoustic imaging (PAI), which provides a higher spatial resolution than pure near infrared fluorescence imaging (NIRF). Because of its successful use in clinical and preclinical examinations, we chose ICG as PAI cell labeling agent. Optimal incubation conditions were defined for an efficient and clinically translatable MSC labeling protocol, such that no cytotoxicity or alterations of the phenotypic profile were observed, and a consistent intracellular uptake of the molecule was achieved. Suspensions of ICG-labeled cells were both optically and optoacoustically detected in vitro, revealing a certain variability in the photoacoustic spectra acquired by varying the excitation wavelength from 680 to 970 nm. Intramuscular engraftments of ICG-labeled MSCs were clearly visualized by both PAI and NIRF over few days after transplantation in the hindlimb of healthy mice, suggesting that the proposed technique retains a considerable potential in the field of transplantation-focused research and therapy. Stem cells were labeled with the Food and Drug Administration (FDA)-approved fluorescent dye ICG, and detected by both PAI and OI, enabling to monitor the cell fate safely, in dual modality, and with good sensitivity and improved spatial resolution.

Real-Time Fluorescent Sentinel Lymph Node Mapping with Indocyanine Green in Women with Previous Conization Undergoing Laparoscopic Surgery for Early Invasive Cervical Cancer: Comparison with Radiotracer ± Blue Dye

Study ObjectiveTo evaluate the added value of the fluorescence dye indocyanine green (ICG) for sentinel lymph node (SLN) mapping in women with cervical cancer who had undergone previous conization (stage 1A-1B1) by comparing ICG versus Tc99m radiotracer + blue dye (BD). DesignRetrospective study (Canadian Task Force classification II-2). SettingTwo European academic medical centers, San Gerardo Hospital, Italy and University of Berne, Switzerland. PatientsSixty-five women with early stage (IA-IB1) cervical cancer who had undergone previous conization and who underwent SLN mapping with Tc99m ± BD (n = 23) or ICG (n = 42) followed by pelvic lymphadenectomy and fertility-sparing surgery or hysterectomy were included in this analysis. InterventionOverall detection rate and bilateral SLN mapping rates of ICG were compared with those obtained using the standard Tc99m radiocolloid and BD. Measurement and Main ResultsOverall, 220 SLNs were detected. The median number of SLNs per patient in the Tc99m ± BD group was 2 (range, 1–5) and in the ICG group, 3 (range, 2–15). The detection rate of SLNs was 95.7% in Tc99m ± BD group and 100% in the ICG group (p = .354). The women injected with ICG had a higher rate of bilateral mapping of the SLNs as compared with the Tc99m ± BD group (95.2% vs 69.6%, p = .016%). Only 12% of the patients (8/65) presented metastatic nodes, 2 in the Tc99m ± BD group and 6 in the ICG group. ConclusionIn early-stage cervical cancer patients conization had no significant impact on the SLN detection rate using both techniques (ICG and radiotracer ± BD). In this scenario a higher bilateral mapping rate was confirmed using the fluorescent dye ICG rather than the standard techniques.

Sentinel lymph node mapping in patients with stage I endometrial carcinoma: a focus on bilateral mapping identification by comparing radiotracer Tc99m with blue dye versus indocyanine green fluorescent dye.

The aim of this study was to compare technetium radiocolloid (Tc99m)+blue dye (BD) versus Indocyanine green (ICG) fluorescent dye in terms of the overall detection rate and bilateral sentinel lymph node (SLN) mapping in patients with endometrial carcinoma. Patients from five European centers with apparently confined clinical stage I endometrial cancer were reviewed. A comparison was made between women who received SLN mapping with pelvic and/or aortic lymphadenectomy (LND), and women who underwent SLN algorithm (SA), was also performed between the two groups. Three hundred and forty-two (342) women were involved (147 in the Tc99m+BD group and 195 in the ICG group). The overall detection rate of SLN biopsy was 97.3% (143/147) for women in the Tc99m+BD group and 96.9% (189/195) for women in the ICG group (p=0.547). The bilateral mapping rate for ICG was 84.1%-significantly higher with respect to the 73.5% obtained with Tc99m+BD (p=0.007). No differences in overall sensitivity (OS) and overall false negative rate (FNR) were seen between LND and SA (p value=0.311), whereas the negative predictive value (NPV) was in favor of SA group (p value=0.030). In this study, fluorescent mapping using ICG resulted equivalent to the standard combined radiocolloid and BD, but real-time SLN mapping achieves a higher bilateral detection rate. The added value that this fast emerging technology promises to give certainly warrants future studies to further consolidate the advantages there are over the standard technique.

Fibro-Lipo-Lymph-Aspiration With a Lymph Vessel Sparing Procedure to Treat Advanced Lymphedema After Multiple Lymphatic-Venous Anastomoses: The Complete Treatment Protocol.

In lymphedema, excess adipose tissue occurs with progression of the disease because of chronic lymph stasis, impeding lymphatic flow. Recently, liposuction has been used as a less-invasive procedure to remove this excess tissue. Given the existing poor lymph drainage in patients with lymphatic diseases, extra caution should be taken to avoid damaging lymphatic vessels during liposuction. We developed a new technique (Fibro-Lipo-Lymph-Aspiration with a Lymph Vessel Sparing Procedure [FLLA-LVSP]) to improve chronic swelling in patients with advanced lymphedema. The FLLA-LSVP highlights the superficial lymphatic pathways in the treated limb. This visibility allows surgeons to avoid these pathways, while removing the maximum amount of excess tissue. One hundred forty-six patients with primary or secondary lymphedema that had already been treated by lymphatic microsurgery, in Genoa, Italy, were included in this retrospective study. All patients had residual fibrotic/adipose tissue, resistant to conservative treatments. Indocyanine green fluorescent dye and Blue Patent Violet dye were injected laterally/medially to the main superficial veins at the wrist/ankle of the limb to be treated. Using a photodynamic camera, the superficial lymphatic network was made visible and sketched onto the skin in indelible ink. After the microlymphography, the excess adipose tissue was carefully aspirated. Preoperative and postoperative excess limb volume was calculated using circumferential measurements and the formula of a frustum. For the upper limb, 0.80 L, on average, and 2.42 L for the lower limb were removed with the FLLA-LVSP. For the upper limb, there was an average presurgery excess volume of 20.19%, which reduced to 2.68% after the FLLA-LVSP (Z score = -6.90, P < 0.001). Similarly, for the lower limb, there was an average presurgery excess limb volume of 21.24% and a reduction to 2.64% postoperatively (Z score = -3.57, P < 0.01). Immediate postoperative microlymphography and Blue Patent Violet test confirmed no lymphatic complications. No episodes of postoperative infection occurred. The FLLA-LVSP is efficient. An entire leg can be completed within 90 minutes. Recovery time is short, and cosmetic results are immediate. More importantly, the removal of excess tissue is completed without further damage to lymphatic vessels. When used after microsurgery, FLLA-LVSP offers the possibility of removing almost all obstacles to lymphatic flow.

ICG Fluorescence Technique for the Detection of Sentinel Lymph Nodes in Breast Cancer: Results of a Prospective Open-label Clinical Trial.

Introduction: Detection of sentinel lymph nodes (SLN) is the standard procedure to evaluate axillary lymph node status in breast cancer. In addition to known and established procedures such as the blue dye method and scintigraphy, this study investigated the efficacy of a method based on use of the fluorescent dye indocyanine green (ICG). Patients and Method: A total of 126 women with breast cancer histologically verified by punch biopsy were studied during surgical removal of SLN. In addition to SLN marking with technetium and scintigraphy, intra-individual comparison was done using indocyanine green (ICG) for marking instead of the standard blue dye. Results: Scintigraphy had a detection rate of 96 %; the detection rate with ICG was just under 89 %. A body mass index (BMI) > 40 was found to be a limiting factor for the fluorescent method. Investigation into potential toxicities associated with the use of the fluorescent dye ICG revealed no systemic or even local side effects. The fluorescent method was found to be significantly less expensive than the scintigraphy method. Conclusion: The ICG fluorescence technique for the detection of SLN was found to be a valid and feasible method in clinical practice when compared directly with the blue dye method and scintigraphy.

Indocyanine green fluorescent dye during bowel surgery: Are the blood supply “guessing days” over?

Assessing the blood supply of the bowel is a difficult task even for experienced surgeons. Laser-assisted indocyanine green (ICG) fluorescent dye angiography provides intraoperative visual assessment of blood flow to the bowel wall and surrounding tissues, allowing for modification to the surgical plan, which can reduce the risk of postoperative complications. ICG angiography was prospectively performed in a single center during a 1-year period for small bowel ischemia and left colorectal resections. ICG angiography played a major role in the intraoperative decision making in 4 of 160 patients, whose clinical and operative details are here reported. In case of acute small intestine ischemia, resection is not warranted unless absolute perfusion units are below 19 (relative 21%). When evaluating blood supply to the left colon prior to anastomosing, resection is recommended with absolute units lower than 18 (relative 31%) even if the bowel appears macroscopically perfused.

Vascularized Supraclavicular Lymph Node Transfer for Lower Extremity Lymphedema Treatment

Sir:FigureMicrosurgical methods for lymphedema treatment such as vascularized lymph node transfer are gaining popularity. Most reports of vascularized lymph node transfer have been for the treatment of upper extremity lymphedema, for which superficial groin lymph nodes are typically transferred.1–4 For lymphedema involving the lower extremities, the potential donor sites for lymph nodes are limited. The axillary and submental regions have served as donor sites for vascularized lymph nodes to treat lower extremity lymphedema, but both have major disadvantages.5 Harvesting lymph nodes from the axillary region may cause lymphedema of the upper extremity, and harvest from the submental region results in a visible donor-site scar and the potential for injury to the marginal mandibular nerve. In a search for a better source of vascularized lymph nodes for transfer to treat lower limb lymphedema, we have used the free supraclavicular flap with its deep cervical lymph nodes (Fig. 1). The advantages include no risk of secondary lymphedema or nerve damage at the donor site; in addition, the donor site scar is well hidden. To our knowledge, this is the first report of using the supraclavicular flap as a vascularized lymph node transfer for treatment of lymphedema.Fig. 1: Illustration showing the design of the supraclavicular free flap.The flap is designed as an ellipse in a horizontal orientation just above the clavicle, with the posterior border of the sternocleidomastoid muscle as the midpoint. First, the inferior skin incision is made, and the dissection proceeds lateral to medial until the transverse cervical artery and transverse cervical vein are identified. A handheld Doppler device can be used to identify a perforator; its location can be marked on the skin to facilitate postoperative monitoring. It is not always necessary to visually identify the perforator to the overlying skin; the vessel is small and can be injured if excessive dissection occurs. The larger lymph nodes are often visible and also palpable. Indocyanine green fluorescent dye can be used to confirm the vascularity of the lymph nodes. The recipient site is prepared at the dorsal crease of the ankle, where the anterior tibial artery and veins are dissected out. The flap is transferred to the recipient site, the microvascular anastomoses are performed, and the flap is inset. The donor site is closed primarily. The postoperative course includes gentle wrapping with a compression bandage and elevation. The dangling protocol starts on postoperative day 5, and the patient increases ambulation progressively with full weight-bearing as tolerated (Fig. 2).Fig. 2: (Left) Preoperative view. (Right) Three-month postoperative view. There has been a 23 percent reduction in volume differential, and the leg is significantly softer and lighter. Note the supraclavicular free flap at the ankle.We have used vascularized supraclavicular lymph node transfer for treatment of advanced lymphedema affecting the leg. The donor-site scar is well hidden, and there is no risk of secondary lymphedema or nerve damage at the donor site. Our preliminary results have been very encouraging. Ghazi A. Althubaiti, M.D. Melissa A. Crosby, M.D. David W. Chang, M.D. Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center, Houston, Texas DISCLOSURE The authors have no financial interests or commercial associations to declare in relation to the content of this article.

Mechanistic Study of Bleach-Imaged Plasmon Propagation (BlIPP)

Bleach-imaged plasmon propagation, BlIPP, is a far-field microscopy technique developed to characterize the propagation length of surface plasmon polaritons in metallic waveguides. To correctly extract the propagation length from the measured photobleach intensity, it is necessary to understand the mechanism by which dye photobleaching occurs. In particular, 1- vs 2-photon bleaching reactions yield different propagation lengths based on a kinetic model for BlIPP. Because a number of studies have reported on the importance of 2-photon processes for dye photobleaching, we investigate here the nature of the photobleaching step in BlIPP. We are able to demonstrate that only 1-photon absorption is relevant for typical BlIPP conditions as tested here for a thin film of indocyanine green fluorescent dye molecules coated over gold nanowires and excited at a wavelength of 785 nm. These results are obtained by directly measuring the excitation intensity dependence of the photobleaching rate constant of the dye in the presence of the metallic waveguide.

Detection of pleural lymph flow using indocyanine green fluorescence imaging in non-small cell lung cancer surgery: a preliminary study

Lymphatic spread of lung carcinoma to the mediastinum is a key determinant of prognosis. The lymph flow often carries metastases from the pulmonary segment directly into the mediastinal lymph nodes, without passing through the hilar nodes. This phenomenon is termed as "skip metastasis." This study investigated the subpleural lymphatic flow to the mediastinum using indocyanine green (ICG) with a near-infrared fluorescence imaging system. Seventeen patients with lung cancer were enrolled in this study. A 0.3ml sample of solution containing the fluorescent dye ICG (5mg/ml) was injected into subpleural sites near the primary tumor. Fluorescence imaging was used to monitor the flow of ICG-containing lymph from the injection site for 5min. The relationship between the anatomical segment of the primary tumor and the lymphatic flow was assessed. The lymphatic vessels draining from the injection site were revealed by the bright ICG fluorescence in 14 of the patients (82.4%). A direct lymphatic flow to the mediastinum was confirmed in 3 of those 14 (21.4%). These findings confirm the direct flow of lymph to the mediastinum without passage through the hilum pulmonis intraoperatively. These preliminary results may provide a valuable clue for further investigations of the mechanisms underlying skip metastasis.

The Importance of a Skin Bridge in Peripheral Tissue Perfusion in Perforator Flaps

Perforator flaps are increasingly used in reconstructive surgery. However, the microvascular perfusion pattern within these flaps remains essentially unknown. In perforator flaps, the importance of preserving the skin bridge at the base is still an object of debate. The authors hypothesized that dividing the skin bridge will increase peripheral tissue perfusion in islanded perforator flaps. The abdominal panniculus in patients submitted to elective abdominoplasty was used (n = 24). Flap perfusion was measured by dynamic laser-induced fluorescence videoangiography. The fluorescent dye indocyanine green was injected intravenously before and after conversion of a perforator flap with an intact skin bridge into an islanded perforator flap. To evaluate perfusion, mean pixel intensity and mean perfusion index were calculated in a control zone and in two zones in the flap. In zone I (the most peripheral zone), surgical release of the skin bridge increased mean pixel intensity (19.1 ± 1.9 versus 24.1 ± 2.1; p < 0.001). The mean perfusion index was calculated as 7.5 ± 5.5 and 12.6 ± 6.3 before and after surgical conversion to islanded perforator flaps, respectively. In zone II (the more proximal zone), mean pixel intensity increased (from 30.8 ± 2.8 to 33.7 ± 2.3; p < 0.001) after surgical release of the skin bridge. The mean perfusion index was 18.5 ± 11.1 and 15.6 ± 6.2. In this human experimental study, conversion of a perforator flap with a skin bridge into an islanded perforator flap increases peripheral tissue perfusion. This finding provides a physiologic basis for using islanded perforator flaps, with enhanced flap mobility and length.

An Investigation of the Application of Laser-Assisted Indocyanine Green Fluorescent Dye Angiography in Pedicle Transverse Rectus Abdominus Myocutaneous Breast Reconstruction

Pedicle transverse rectus abdominus myocutaneous (pTRAM) flaps remain the most common method of autologous tissue breast reconstruction. Using pTRAM flaps, complications often arise postoperatively, secondary to inadequate circulation. Tissues from distant angiosomes are associated with poorer perfusion, but this differs among patients. Many modalities have been used to reduce the risk of complications, but none have achieved widespread application. The authors believe that laser-assisted indocyanine green fluorescent dye angiography (LA-ICGA) can potentially reduce the risk of complications. In two routine, single-pedicle, ipsilateral pTRAM flaps, LA-ICGA imaging was performed following the division of the distal rectus muscle and deep inferior epigastric pedicle. The resulting images were used to guide design of the flap and debridement. In case 1, good perfusion was observed in zone 1 and part of zone 2. In case 2, good perfusion was observed in zone 1 and 50% of zone 3, with little perfusion in zone 2. In both cases, tissues with poor perfusion were debrided before transfer and inset. In both patients, there were no issues with wound healing, tissue necrosis or fat necrosis. The variability of perfusion of the pTRAM flap among individuals is well appreciated. LA-ICGA helped to determine the limits of good perfusion and, therefore, the limits of tissue to be preserved for transfer and inset. This helped to avoid harvesting poorly perfused tissue that would have almost certainly experienced necrosis and, ultimately, would have reduced the risk of postoperative complications.

An investigation of the application of laser-assisted indocyanine green fluorescent dye angiography in pedicle transverse rectus abdominus myocutaneous breast reconstruction

An investigation of the application of laser-assisted indocyanine green fluorescent dye angiography in pedicle transverse rectus abdominus myocutaneous breast reconstruction

The Application of Laser-Assisted Indocyanine Green Fluorescent Dye Angiography in Microsurgical Breast Reconstruction

The Application of Laser-Assisted Indocyanine Green Fluorescent Dye Angiography in Microsurgical Breast Reconstruction

Early Experience with Fluorescent Angiography in Free-Tissue Transfer Reconstruction

Soft-tissue and bony reconstruction with free-tissue transfer is one of the most versatile tools available to the reconstructive surgeon. Determination of flap perfusion and early detection of vascular compromise with prompt correction remain critical in free-tissue transfer success. The aim of this report is to describe the utility of laser-assisted indocyanine green fluorescent dye angiography in free-tissue transfer reconstruction. From October of 2007 to March of 2008, 27 nonrandomized, nonconsecutive patients underwent surgical free flaps in conjunction with intraoperative Novadaq SPY fluorescent angiography. Twenty-seven patients underwent 29 free-tissue transfers. There was one partial flap loss in this group requiring operative revision. No complications attributable to indocyanine green fluorescent dye administration were noted. Imaging procedures (including dye administration) added minimal additional time to the operative time and anesthesia, and assisted in intraoperative decision-making. Novadaq's SPY fluorescent angiography system provides simple and efficient intraoperative real-time surface angiographic imaging. This technology places control of vascular anastomosis evaluation and flap perfusion in the hands of the surgeon intraoperatively in a visual manner that is easy to use and is helpful in surgical decision-making.