Indocyanine-green fluorescence video angiography used clinically to evaluate tissue perfusion in microsurgery.
BACKGROUND
Laser-induced fluorescence angiography with indocyanine-green (ICG-FA) is a new diagnostic approach that allows quantitative evaluation of tissue perfusion in microsurgery as well as an analysis of the uptake, distribution, and clearance of dye-marked blood.


METHODS
The ICG-FA technique was evaluated for its sensitivity and prognostic value in comparison with clinical parameters (turgor, temperature, reperfusion time, bleeding after puncture) during and after different surgical procedures. Altogether, 91 measurements were made in cases of microvascular repair (n = 43) and free-flap surgery (n = 48).


RESULTS
Because of discrepancies between ICG-FA results and clinical findings, the planned postoperative management was changed 43 times (47.2%). In cases of microvascular repair that subsequently resulted in tissue necrosis, ICG fluorescence had a significantly higher prognostic value than any of the clinical parameters (p = 0.03). During free-flap surgery, intraoperative ICG-FA had better sensitivity for flap loss than clinical parameters, but postoperative ICG-FA did not.


CONCLUSIONS
Fluorescence angiography with ICG is a sensitive diagnostic tool for detecting compromised tissue perfusion in trauma surgery and microsurgery. Its use may improve perioperative management and thereby lead to better clinical results.
Mothes
Henning
H
Department of Traumatology, University Hospital Jena, Germany.
Dönicke
Torsten
T
Friedel
Reinhard
R
Simon
Mark
M
Markgraf
Eberhard
E
Bach
Olaf
O
D000293:Adolescent; D000328:Adult; D000368:Aged; D000671:Amputation, Surgical; D001775:Blood Circulation / Q000502:physiology*; D002648:Child; D002675:Child, Preschool; D004396:Coloring Agents; D005260:Female; D005451:Fluorescein Angiography; D006230:Hand Injuries / Q000601:surgery*; D006801:Humans; D007208:Indocyanine Green; D007834:Lasers; D008297:Male; D008866:Microsurgery / Q000295:instrumentation / Q000379:methods*; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009336:Necrosis; D011379:Prognosis; D013524:Surgical Flaps / Q000098:blood supply* / Q000473:pathology
D004396:Coloring Agents; D007208:Indocyanine Green