Assessment of deep inferior epigastric perforator flap perfusion with near-infrared fluorescence: A pilot study and description of a standardized working protocol

Michi, Marlies; Verduijn, Pieter S.; Corion, Leonard U. M.; Vahrmeijer, Alexander L.; Mulder, Babs G. Sibinga

doi:10.1016/j.bjps.2021.11.043

Cited by 5 publications

(6 citation statements)

References 30 publications

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“…One randomized controlled study was identified (Varela et al, 2020), and others were all cohort studies. Data from five double‐arm studies were extracted for the meta‐analysis (Hembd et al, 2020; Malagón‐López, Vilà, et al, 2019; Michi et al, 2022; Varela et al, 2020; Yoo et al, 2022). The level of evidence and risk of bias of included studies were presented in Table 1 and Supplemental Appendix 1.…”

Section: Resultsmentioning

confidence: 99%

“…A total of five studies, presenting 1021 patients (459 in the ICG group, 562 in the control group), were enrolled (Hembd et al, 2020; Malagón‐López, Vilà, et al, 2019; Michi et al, 2022; Varela et al, 2020; Yoo et al, 2022). All studies had a follow‐up period exceeding 6 months.…”

Section: Resultsmentioning

confidence: 99%

“…Despite the popularity of ICG‐A in DIEP flap surgery, whether clinical outcomes benefit from ICG‐A remains to be discussed (Duggal et al, 2014; Parmeshwar et al, 2021; Pruimboom, Schols, et al, 2020). Moreover, new evidence has been added to this field recently (Hembd et al, 2020; Malagón‐López, Vilà, et al, 2019; Michi et al, 2022; Varela et al, 2020; Yoo et al, 2022). To address these problems, we conducted a systematic review and meta‐analysis.…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, new evidence has been added to this field recently (Hembd et al, 2020;Michi et al, 2022;Varela et al, 2020;Yoo et al, 2022). To address these problems, we conducted a systematic review and meta-analysis.…”

Section: Introductionmentioning

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: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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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“…In free flap breast reconstruction cases, ICG angiography can help surgeons predict Hartrampf 's zones of perfusion and decide whether to super-or turbo-charge flaps to prevent fat necrosis (Fig. 3) [26][27][28]. utilized in various other types of free flap surgery including lower extremity or head and neck reconstruction to minimize postoperative complications from flap necrosis [29][30][31].…”

Section: Breast Reconstructionmentioning

confidence: 99%

Utility of Indocyanine Green Fluorescence Imaging in Wound Assessment

Gyu¹

2023

J Wound Manag Res

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The use of indocyanine green fluorescence imaging has become popular in the field of reconstructive surgery as it allows surgeons to confirm flap vascularity and lymphatic flow. Based on its reliability in detecting tissue perfusion, it is now being used to evaluate the status of wounds which helps surgeons make accurate intraoperative and postoperative decisions. This article aims to provide an overview of indocyanine green fluorescence imaging and its current utility in assessment of various wounds.

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Clinical and Cost‐Effectiveness of Intraoperative Flap Perfusion Assessment With Indocyanine Green Fluorescence Angiography in Breast and Head and Neck Reconstructions: A Systematic Review and Meta‐Analysis

Singaravelu,

McCarrick,

Potter

et al. 2024

Microsurgery

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BackgroundIndocyanine green fluorescence angiography (ICGFA) is gaining popularity for the assessment of reconstructive flap perfusion intraoperatively. This study analyses the literature with a focus on its clinical efficacy and cost‐effectiveness across various plastic and reconstructive surgery procedures.MethodsA systematic review was conducted in accordance with PRISMA guidelines on published studies in English comparing ICGFA with standard clinical assessment for flap perfusion. Meta‐analysis concerned perfusion‐related complications and cost data.ResultsTwenty‐five studies met the inclusion criteria, of which two were randomized controlled trials (RCTs) and four were prospective cohort studies. Twenty‐one studies were AHRQ Standard ‘Good’; however, the overall level of evidence remains low. ICGFA was predominantly performed in breast surgeries (n = 3310) and head and neck reconstruction (n = 701) albeit with inconsistency in protocols and predominantly subjective interpretations (only five studies utilized objective thresholds). In breast surgery, meta‐analysis demonstrated significant reductions in mastectomy skin flap necrosis (odds ratio (OR) 0.58, p < 0.0001), fat necrosis (OR 0.31, p < 0.001), infection (OR 0.66, p = 0.02), and re‐operation (OR 0.40, p < 0.0001), but no significant decrease in total or partial flap loss (OR 0.78, p = 0.57/OR 0.87, p = 0.56, respectively) or increase in dehiscence (OR 1.55, p = 0.11). In head and neck surgery, ICGFA significantly decreased total flap loss (OR 0.47, p = 0.04), although not partial flap loss (OR 0.37, p = 0.13) and reoperation (OR 0.92, p = 0.73). Lower limb (n = 104) and abdominal wall (n = 95) reconstructive surgeries were much less studied with no significant ICGFA impact. Seven studies reported cost savings with flap surgeries and breast reconstructions, although study heterogeneity precluded meta‐analysis.ConclusionsICGFA appears to be a useful, cost‐effective tool to identify otherwise unsuspected hypoperfusion in breast and head and neck reconstruction. There is a clear need for standardization, however, to avoid bias. Further RCTs are necessary to solidify these promising clinical findings.

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Assessment of deep inferior epigastric perforator flap perfusion with near-infrared fluorescence: A pilot study and description of a standardized working protocol

Cited by 5 publications

References 30 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

Utility of Indocyanine Green Fluorescence Imaging in Wound Assessment

Clinical and Cost‐Effectiveness of Intraoperative Flap Perfusion Assessment With Indocyanine Green Fluorescence Angiography in Breast and Head and Neck Reconstructions: A Systematic Review and Meta‐Analysis

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