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Laser-assisted indocyanine green angiography: a critical appraisal.
Ann Plast Surg 2013; 70(5):613-9AP

Abstract

BACKGROUND

Laser-assisted indocyanine green angiography (ICG-A) has been promoted to assess perfusion of random skin, pedicled, and free flaps. Few studies address its potential limitations.

METHODS

Thirty-seven patients who underwent reconstructive procedures with ICG-A were studied retrospectively to determine the correlation between clinical findings and ICG-A. Indocyanine green angiography underestimated perfusion when areas of less than or equal to 25% uptake were not debrided and remained perfused. Indocyanine green angiography overestimated perfusion when areas with greater than 25% uptake developed necrosis.

RESULTS

Of 14 random skin flaps, ICG-A underestimated perfusion in 14% and overestimated in 14%. In 16 patients undergoing perforator flap breast reconstruction, ICG-A correlated with computed tomographic angiogram (CTA) in 85%. Indocyanine green angiography underestimated perfusion in 7% and overestimated in 7%. In 8/11 patients undergoing fasciocutaneous flaps, ICG-A aided in donor site selection. In 3/6 ALT flaps, a better unilateral blush was found that correlated with Doppler. In all 3, a dominant perforator was found. In 11 patients, there was a 9% underestimation of flap perfusion. In 3 pedicled flaps, there was a 66% underestimation and 33% overestimation of perfusion.

CONCLUSIONS

Indocyanine green angiography often confirmed our clinical/radiologic findings in abdominal perforator and fasciocutaneous flaps. It tended to underestimate perfusion in pedicle and skin flaps. When clinical examination was obvious, ICG-A rendered clear-cut findings. When clinical examination was equivocal, ICG-A tended to provide ambiguous findings, demonstrating that a distinct cutoff point does not exists for every patient or flap. Indocyanine green angiography is a promising but expensive technology that would benefit from standardization. Further research is needed before ICG-A can become a reliable tool for surgeons.

Authors+Show Affiliations

Division of Plastic and Reconstructive Surgery, University of North Carolina, Chapel Hill, NC 27599-7195, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Studies
Journal Article

Language

eng

PubMed ID

23579465

Citation

Wu, Cindy, et al. "Laser-assisted Indocyanine Green Angiography: a Critical Appraisal." Annals of Plastic Surgery, vol. 70, no. 5, 2013, pp. 613-9.
Wu C, Kim S, Halvorson EG. Laser-assisted indocyanine green angiography: a critical appraisal. Ann Plast Surg. 2013;70(5):613-9.
Wu, C., Kim, S., & Halvorson, E. G. (2013). Laser-assisted indocyanine green angiography: a critical appraisal. Annals of Plastic Surgery, 70(5), pp. 613-9. doi:10.1097/SAP.0b013e31827565f3.
Wu C, Kim S, Halvorson EG. Laser-assisted Indocyanine Green Angiography: a Critical Appraisal. Ann Plast Surg. 2013;70(5):613-9. PubMed PMID: 23579465.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Laser-assisted indocyanine green angiography: a critical appraisal. AU - Wu,Cindy, AU - Kim,Sendia, AU - Halvorson,Eric G, PY - 2013/4/13/entrez PY - 2013/4/13/pubmed PY - 2013/10/26/medline SP - 613 EP - 9 JF - Annals of plastic surgery JO - Ann Plast Surg VL - 70 IS - 5 N2 - BACKGROUND: Laser-assisted indocyanine green angiography (ICG-A) has been promoted to assess perfusion of random skin, pedicled, and free flaps. Few studies address its potential limitations. METHODS: Thirty-seven patients who underwent reconstructive procedures with ICG-A were studied retrospectively to determine the correlation between clinical findings and ICG-A. Indocyanine green angiography underestimated perfusion when areas of less than or equal to 25% uptake were not debrided and remained perfused. Indocyanine green angiography overestimated perfusion when areas with greater than 25% uptake developed necrosis. RESULTS: Of 14 random skin flaps, ICG-A underestimated perfusion in 14% and overestimated in 14%. In 16 patients undergoing perforator flap breast reconstruction, ICG-A correlated with computed tomographic angiogram (CTA) in 85%. Indocyanine green angiography underestimated perfusion in 7% and overestimated in 7%. In 8/11 patients undergoing fasciocutaneous flaps, ICG-A aided in donor site selection. In 3/6 ALT flaps, a better unilateral blush was found that correlated with Doppler. In all 3, a dominant perforator was found. In 11 patients, there was a 9% underestimation of flap perfusion. In 3 pedicled flaps, there was a 66% underestimation and 33% overestimation of perfusion. CONCLUSIONS: Indocyanine green angiography often confirmed our clinical/radiologic findings in abdominal perforator and fasciocutaneous flaps. It tended to underestimate perfusion in pedicle and skin flaps. When clinical examination was obvious, ICG-A rendered clear-cut findings. When clinical examination was equivocal, ICG-A tended to provide ambiguous findings, demonstrating that a distinct cutoff point does not exists for every patient or flap. Indocyanine green angiography is a promising but expensive technology that would benefit from standardization. Further research is needed before ICG-A can become a reliable tool for surgeons. SN - 1536-3708 UR - https://www.unboundmedicine.com/medline/citation/23579465/Laser_assisted_indocyanine_green_angiography:_a_critical_appraisal_ L2 - http://dx.doi.org/10.1097/SAP.0b013e31827565f3 DB - PRIME DP - Unbound Medicine ER -