Intraoperative Indocyanine Green Fluorescence Angiography Is Sensitive for Predicting Postoperative Wound Complications in Soft-Tissue Sarcoma Surgery

Abstract

Introduction: Indocyanine green (ICG) angiography is a novel technology that has been predictive of postoperative wound complications. It is unknown whether this technology can successfully predict complications after sarcoma resection. In this study, we aimed to evaluate the sensitivity and specificity of ICG angiography in predicting postoperative wound complications after soft-tissue sarcoma resection. Methods: A prospective cohort study of 23 patients was performed beginning October 2017 at our institution. Patients who underwent soft-tissue sarcoma resection were included. After tumor resection and wound closure, evaluation of tissue perfusion in skin edges was performed with ICG angiography. Wound complications were recorded in the postoperative follow-up. Results: Eight patients developed postoperative wound complications. Six patients were predicted to have wound complications on the final ICG scans. The accuracy of ICG angiography was dependent on the anatomic location, with improved accuracy in the lower extremity. ICG angiography had a sensitivity of 50%, a specificity and a positive predictive value of 100%, and a negative predictive value of 70% for wound complications after soft-tissue sarcoma resections located in the lower extremity. Conclusion: ICG angiography has a high predictive value in the lower extremity for postoperative wound complications. Level of Evidence: Level III, Diagnostic

Cost Variance in Patients With Soft Tissue Sarcoma Who Develop Postoperative Wound Complications

“…It has been shown that 30% to 40% of patients who receive preoperative radiation will develop a postoperative wound complication. 1 , 11 , 12…”

“…Owing to the high rate of wound complications in this patient population, many previous studies have focused on identifying the risk factors for developing a wound complication and ways to mitigate these risks, with varying success. 1 2 3 4 5 6 7 8 , 11 For example, a report by Bedi et al 2 described lower wound complications with vacuum-assisted wound closure in lower extremity sarcomas. A more recent study reported lower wound complication rates with the utilization of indocyanine green fluorescence angiography during wound closure.…”

“…A more recent study reported lower wound complication rates with the utilization of indocyanine green fluorescence angiography during wound closure. 11 …”

“…These variables have been shown to be associated with postoperative wound complications, and our findings support these previous studies. 4 , 8 , 11 …”

Uso de verde de indocianina en cirugía reconstructiva y quemaduras

“…Hay datos que muestran la reducción de los costes de tratamiento gracias al uso de ICG 8 . Wilke et al, realizaron un estudio de cohorte prospectivo en 23 pacientes para establecer la sensibilidad del ICG para predecir las complicaciones posoperatorias relacionadas con la cirugía del sarcoma de tejidos blandos 9 .…”