Indocyanine Green Fluorography in Plastic Surgery and Microvascular Surgery

Indocyanine green (ICG) fluorography which is used to visualize the arteries, veins, and lymphatic vessels through the skin surface has recently been developed. This article includes an overview of our clinical experiences as well as descriptions of the latest knowledge on the utilization of ICG fluorography in the fields of plastic surgery and microvascular surgery. Imaging of the Capillary Blood Flow: To predict the future survival and necrosis, ICG fluorography is useful in various situations such as to examine injured limbs, skin flaps with a poor blood flow or ischemic limbs due to arteriosclerosis obliterans. Imaging of the Arteries: Practical pictures of a subcutaneous artery can be obtained for preoperative evaluations of the nutrient vessels of a skin flap and the blood flow within a skin flap. It is particularly useful for planning the use of a perforator-based flap. Imaging of the Lymphatic Vessels: ICG lymphography makes it possible to easily detect the functional lymphatic vessels in lymphaticovenous anastomosis for lymphedema of the extremities after either a surgical lymph node dissection or radiotherapy. Imaging of the Veins: With near-infrared skin imaging after the systemic administration of ICG, a clear picture of the subcutaneous veins, approximately 1 to 2 cm from the surface, can be obtained. ICG venography has various utilizations in flap surgery and peripheral vascular surgery. A clinical application of this method in internal shunt creation is presented in this article. It is expected that various new uses and applications for ICG fluorography will therefore be developed in the future.