title: An Analysis of Current Techniques Used for Intraoperative Flap Evaluation.
abstract: BACKGROUND
  Over the last decade, microsurgeons have used a greater variety of more complex flaps. At the same time, microsurgeons have also become more interested in technology, such as indocyanine green (ICG) angiography, dynamic infrared thermography (DIRT), and photospectrometry, for preoperative planning and postoperative monitoring. These technologies are now migrating into the operating room, and are used to optimize flap design and to identify areas of hypoperfusion or problems with the anastomoses. Although relatively more has been published about ICG angiography, information is generally lacking about the intraoperative role of these techniques.
  
  
  METHODS
  A systematic analysis of articles discussing intraoperative ICG angiography, DIRT, and photospectrometry was performed to better define the sensitivity, specificity, expected outcomes, and potential complications associated with these techniques.
  
  
  RESULTS
  For intraoperative ICG angiography, the sensitivity was 90.9% (95% CI: 77.5-100) and the accuracy was 98.6% (95% CI: 97.6-99.7). The sensitivity of DIRT was 33% (95% CI: 11.3-64.6), the specificity was 100% (95% CI: 84.9-100), and the accuracy was 80% (95% CI: 71.2-89.7). The sensitivity of intraoperative photospectrometry was 92% (95% CI: 72.4-98.6), the specificity was 100% (95% CI: 98.8-100), and the accuracy was also 100% (95% CI: 98.7-100).
  
  
  CONCLUSIONS
  These technologies for intraoperative perfusion assessment have the potential to provide objective data that may improve decisions about flap design and the quality of microvascular anastomoses. However, more work is needed to clearly document their value.
authors.affiliation: From the *Department of Head, Neck & Plastic Surgery, Roswell Park Cancer Institute, State University of New York, Buffalo, NY; and †Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Lohman
authors.forename: Cemile Nurdan
authors.initials: CN
authors.lastname: Ozturk
authors.forename: Can
authors.initials: C
authors.lastname: Ozturk
authors.forename: Vijayvel
authors.initials: V
authors.lastname: Jayaprakash
authors.forename: Risal
authors.initials: R
authors.lastname: Djohan
mesh_terms: D000792:Angiography / Q000379:methods; D004396:Coloring Agents; D006801:Humans; D007208:Indocyanine Green; D007430:Intraoperative Care / Q000379:methods*; D061848:Optical Imaging; D019651:Plastic Surgery Procedures; D012680:Sensitivity and Specificity; D013524:Surgical Flaps / Q000098:blood supply*; D013817:Thermography / Q000379:methods
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green