title: Intraoperative use of fluorescent imaging with indocyanine green changes management of abdominal wall flaps during open ventral hernia repair.
abstract: BACKGROUND
  Wound complications including infection and necrosis remain common during complex open ventral hernia repair. Advancements or enhancements in imaging technology may abate some of these issues but requires more investigation. Laser-assisted fluorescent imaging with indocyanine green (Spy Elite, LifeCell Corporation, Branchburg, NJ) allows visualization and quantification of perfusion, facilitating management of poorly perfused tissue.
  
  
  METHODS
  Ten patients, who underwent large or massive ventral or incisional hernia repair with biologic graft reinforcement and either perforator-sparing components separation or primary open repair, underwent intraoperative laser-assisted fluorescent imaging with indocyanine green from August 2012 to August 2013. The cases were reviewed by an independent data collector with primary outcomes of postoperative skin infection and/or abdominal wall necrosis.
  
  
  RESULTS
  Three (30%) patients had adequate perfusion, while seven (70%) patients had inadequate skin perfusion and necessitated excision of additional tissue. Of the patients whose ischemic tissue was removed, four (57%) patients had an infection and no patients developed necrosis postoperatively. Of the patients who had no removal of additional skin, one (33%) patient developed an infection and one (33%) patients developed skin necrosis.
  
  
  CONCLUSIONS
  The intraoperative use of laser-assisted fluorescent imaging with indocyanine green may change management of abdominal wall flaps, even in perforator-sparing operations. Our study series is small and cannot suggest statistical significance in the potential benefit of intraoperative imaging, but shows that up to 70% of patients may require change in management due to poorly perfused tissue flaps.
authors.affiliation: Department of Surgery, University of Nevada School of Medicine, 1707 W. Charleston Blvd. Ste. #160, Las Vegas, NV, 89102, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Cho
authors.forename: Audriene
authors.initials: A
authors.lastname: May
authors.forename: Heidi
authors.initials: H
authors.lastname: Ryan
authors.forename: Shawn
authors.initials: S
authors.lastname: Tsuda
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D004396:Coloring Agents; D005260:Female; D005451:Fluorescein Angiography / Q000379:methods*; D006555:Hernia, Ventral / Q000175:diagnosis / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D007208:Indocyanine Green; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D013524:Surgical Flaps
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green