Use of intraoperative indocyanin-green angiography to minimize wound healing complications in abdominal wall reconstruction

Abstract

Complication rates following abdominal wall reconstruction (AWR) remain high. Early complications are related to skin necrosis and delayed healing, whereas late complications are related to recurrence. When concomitant body contouring procedures are performed, complication rates can be further increased. It is hypothesised that fluorescent angiography using indocyanin green (ICG) can identify poorly perfused tissues and thus reduce the incidence of delayed healing. A retrospective review was conducted of all patients who underwent AWR with concomitant panniculectomy from 2007-2012. Intraoperative ICG angiography with the SPY system (LifeCell Corp.) was used to determine the amount of resection for body contouring in patients who underwent reconstruction in a cohort of patients. SPY-Q was used to assess relative perfusion of analysed areas. Preoperative, postoperative, and operative details were analyzed. Seventeen patients met inclusion criteria, 12 patients were included in the non-ICG cohort, while five patients were included in the ICG cohorts. Wound-healing complications occurred in 5/12 (42%) patients in the non-ICG cohort vs 1/5 (20%) of the ICG cohorts. A description of the sole patient with complications in the ICG cohort is illustrated. Operative debridement and wound infection development occurred more frequently in the non-ICG cohort compared with the ICG cohort (17%, 17% vs 0%, 0%, respectively). Average time to wound healing was 41.1 days. Intraoperative ICG angiography can accurately detect perfusion abnormalities and can decrease wound healing related complications in complex hernia repair with concomitant panniculectomy. Assessing and ensuring skin viability can decrease the need for operative debridement.

Intraoperative indocyanine green fluorescence angiography to predict wound complications in complex ventral hernia repair

“…Patel et al [41] demonstrated reduced wound complications with ICG-FA in 5 patients. The authors have also provided the first guideline for the use of ICG-FA in this field: an absolute perfusion unit threshold of ten with a 5 mg dose of ICG with the SPY Elite Ò system.…”

In Vivo Evaluation of a Novel Mesh Suture Design for Abdominal Wall Closure

“…Combining an expertise in wound healing and soft-tissue management with mechanical concepts borrowed from experience with breast and hand surgery, plastic surgeons have been instrumental in the introduction and evaluation of new techniques and materials for abdominal wall reconstruction. 3,4,12–18 However, although these advances have yielded improved surgical outcomes with regard to hernia repair, there has not been an equivalent improvement in the general surgeon’s ability to provide a reliable laparotomy closure. A recent review of outcomes from two large prospective trials reported an incisional hernia rate of 22.4 percent at 3 years, a rate comparable to that reported more than 30 years ago.…”

Abdominal Wall Reconstruction after Decompressive Laparotomy: A Case Utilizing Tissue Expanders, Hybrid Mesh and Component Separation

“…The patient was extremely pleased with his cosmetic outcome and continues to report a much better quality of life after this operation ( Figure 5). ACT scan performed 6 months later showed an intact repair ( Figure 6) [1][2][3][4][5][6][7][8][9][10][11][12][13]. …”