J reconstr Microsurg 2018; 34(02): 077-086
DOI: 10.1055/s-0037-1606536
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Application of Indocyanine Green in Flap Surgery: A Systematic Review

Ke Li*
1  Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
,
Zheng Zhang*
1  Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
,
Fabio Nicoli*
1  Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
2  Department of Plastic and Reconstructive Surgery, University of Rome “Tor Vergata,” Rome, Italy
3  Plastic Reconstructive and Aesthetic Surgery Unit, Villa Salaria Clinic, Rome, Italy
4  Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
,
Christopher D'Ambrosia*
4  Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
5  School of Medicine, Columbia University, New York, New York
,
Wenjing Xi
1  Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
,
Davide Lazzeri
3  Plastic Reconstructive and Aesthetic Surgery Unit, Villa Salaria Clinic, Rome, Italy
,
Shaoqing Feng
1  Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
,
Weijie Su
1  Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
,
Hua Li
1  Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
,
Pedro Ciudad
4  Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
,
Mathias Tremp
6  Plastic Reconstructive and Aesthetic Surgery, University Hospital of Basel, Basel, Switzerland
,
Yi Xin Zhang
1  Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
› Author Affiliations
Further Information

Publication History

12 December 2016

31 July 2017

Publication Date:
09 October 2017 (eFirst)

Abstract

Background The vascularization of the distal portions of transferred tissue represents the most critical factor in the success of reconstructive surgery. In recent years, indocyanine green (ICG) fluorescence imaging techniques have been applied during surgery to evaluate flap perfusion. However, this investigation has found that there is little consensus regarding the standard dose of ICG as well as the pre-operative requirements of ICG allergy testing. The aim of this study is to summarize the applications of ICG to tissue transfers and safe dosing practices and to provide insight to the possible adverse effects of ICG on flap surgery with the goal of helping clinicians apply ICG safely and efficiently to tissue transfer procedures.

Methods A literature search was performed using, Wiley InterScience, and Springer with the key words, ‘Flap,’ ‘indocyanine green,’ ‘surgery,’ and related mesh words for all publications between 2005 and 2015. Title and abstract screening was performed using predefined in- and exclusion criteria.

Results Seventy-three articles were included. These were classified as “application of ICG in flap surgery” and “the security of applying ICG in flap surgery”.

Conclusions ICG fluorescence imaging preoperatively facilitates the detection of perforators in tissue flaps with thickness <20 mm, aids in the evaluation of flap microcirculation and perfusion, and allows surgeons to select dominant cutaneous nerves while evaluating the quality of vascular anastomoses and locating thromboses. The literature also concluded that potential allergic reactions to ICG should be taken into consideration.

* These authors contributed equally to this work.