Clinical Applications of ICG Fluorescence Imaging in Plastic and Reconstructive Surgery

Aims and Background: Compromise in blood supply and failure in tissue transfer are associated with excessive resource costs in plastic surgery. The ability to detect impaired blood supply on the table would contribute to major cost savings for the health care system. Indocyanine green imaging (ICGA) holds promise as a simple method with a high sensitivity and specificity for assessing blood flow in the operating room. Methods: In this review, experimental and clinical studies concerning the use of ICGA in the field of plastic and reconstructive surgery are reviewed. Findings: Possible plastic surgical applications of ICGA range from assessment of flap perfusion in pedicle and free flap surgery to patency assessment of microvascular anastomoses, sentinel node detection, lymph vessel identification, and burn depth estimation. Conclusions: At present ICGA offers the best data-supported estimates of blood supply in reconstructive plastic surgery. Substantial evidence exists that intraoperative ICGA improves the quality of plastic surgical procedures and has the potential to reduce peri-and postoperative morbidity significantly.