Outcome prediction in microsurgery by quantitative evaluation of perfusion using ICG fluorescence angiography.
The purpose of this prospective study was to evaluate the clinical efficacy of laser-induced fluorescence angiography with indocyanine green (ICG-FA) for perioperative monitoring of tissue perfusion in hand surgery. Different quantitative parameters of the uptake, distribution and clearance of dye-marked blood were evaluated for their sensitivity and prognostic value in comparison to each other and to clinical parameters. One hundred and fifty-five measurements were performed prior to, or following, surgery for severe hand injuries. All quantitative parameters of ICG-FA detected intraoperatively were found to be of significant predictive value for outcome, but clinical parameters were not. For the dye uptake, a minimum slope value of 0.01 was significantly related to sufficient perfusion and good prognosis. There was no correlation between the quantitative ICG-FA results or any of the clinical parameters. Since clinical evaluation of perfusion in this surgery remains difficult, the additional use of ICG-FA may improve surgical decision making and, thereby, lead to better clinical results.
Mothes
H
H
Department of Trauma-, Hand- and Reconstructive Surgery, University of Jena, Erlanger Allee, Jena, Germany.
Dinkelaker
T
T
Dönicke
T
T
Friedel
R
R
Hofmann
G O
GO
Bach
O
O
D004396:Coloring Agents / Q000494:pharmacology; D005451:Fluorescein Angiography; D006207:Half-Life; D006225:Hand / Q000098:blood supply*; D006230:Hand Injuries / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D007208:Indocyanine Green / Q000494:pharmacology; D008866:Microsurgery; D016343:Monitoring, Intraoperative / Q000379:methods*; D009336:Necrosis; D019651:Plastic Surgery Procedures; D012039:Regional Blood Flow; D012680:Sensitivity and Specificity
D004396:Coloring Agents; D007208:Indocyanine Green