Assessment of Tissue Viability Following Amputation Surgery Using Near-Infrared Fluorescence Imaging With Indocyanine Green

Quantitative perfusion assessment using indocyanine green during surgery — current applications and recommendations for future use

“…Although normalization enhances reliability and validity by reducing influencing factors, intensity-related parameters are depleted. These absolute parameters, such as maximum intensity, could be useful in the assessment of tissue viability, as was shown in several studies [18,72,101]. Furthermore, normalization of time-intensity curves in areas with low fluorescence intensity (for example within tissue necrosis), i.e., magnifying the signal to 100%, might lead to fluttering of the curves, making them noninterpretable.…”

“…Since the first introduction of ICG for angiography in ophthalmology, the technique has been adopted by various surgical fields, including but not limited to vascular-, gastrointestinal-, cardiac-, and reconstructive surgery [11][12][13][14][15][16][17]. Within vascular surgery, ICG NIR fluorescence imaging has been reported to potentially predict clinical outcomes and guide treatment strategies [18][19][20][21]. In gastrointestinal surgery, tissue perfusion assessment using ICG NIR fluorescence imaging has several promising indications, including anastomosis perfusion evaluation to identify patients at risk for anastomotic leakage [22][23][24].…”

Usefulness of indocyanine green fluorescence angiography for the urgent decision of the level of limb amputation

“…NIR-ICG imaging is a promising tool for visualizing regional tissue perfusion. 2 , 3 It has been used to measure retinal microcirculation since the 1970s and to confirm tissue perfusion in hepatic, cardiac, and plastic surgeries. However, it has been rarely applied in the orthopedic field.…”

“…It assesses the peripheral small vessels proximal to the skin, rather than the large vessels. 2 , 3 In this respect, ICG is superior to CTA. Second, NIR-ICG imaging is performed can be performed instantly at any location.…”

“…It is easy to use and does not expose the patient to radiation. 2 , 3 The tissue hemodynamics are evaluated repeatedly to confirm the planned amputation site, remove excessively tight sutures, and facilitate rapid surgery before necrosis development.…”