Pruimboom Tim, van Kuijk Sander M J, Qiu Shan S, van den Bos Jacqueline, Wieringa Fokko P, van der Hulst René R W J, Schols Rutger M
Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands.
Surg Innov. 2020 Feb;27(1):103-119. doi: 10.1177/1553350619862097. Epub 2019 Jul 26.
. Indocyanine green angiography (ICGA) offers the potential to provide objective data for evaluating tissue perfusion of flaps and reduce the incidence of postoperative necrosis. Consensus on ICGA protocols and information on factors that have an influence on fluorescence intensity is lacking. The aim of this article is to provide a comprehensive insight of in vivo and ex vivo evaluation of factors influencing the fluorescence intensity when using ICGA during reconstructive flap surgery. . A systematic literature search was conducted to provide a comprehensive overview of currently used ICGA protocols in reconstructive flap surgery. Additionally, ex vivo experiments were performed to further investigate the practical influence of potentially relevant factors. . Factors that are considered important in ICGA protocols, as well as factors that might influence fluorescence intensity are scarcely reported. The ex vivo experiments demonstrated that fluorescence intensity was significantly related to dose, working distance, angle, penetration depth, and ambient light. . This study identified factors that significantly influence the fluorescence intensity of ICGA. Applying a weight-adjusted ICG dose seems preferable over a fixed dose, recommended working distances are advocated, and the imaging head during ICGA should be positioned in an angle of 60° to 90° without significantly influencing the fluorescence intensity. All of these factors should be considered and reported when using ICGA for tissue perfusion assessment during reconstructive flap surgery.
吲哚菁绿血管造影术（ICGA）为评估皮瓣组织灌注提供了提供客观数据的潜力，并可降低术后坏死的发生率。目前缺乏关于ICGA方案的共识以及影响荧光强度的因素的相关信息。本文的目的是全面深入了解在重建皮瓣手术中使用ICGA时影响荧光强度的体内和体外因素评估。进行了系统的文献检索，以全面概述重建皮瓣手术中目前使用的ICGA方案。此外，还进行了体外实验，以进一步研究潜在相关因素的实际影响。在ICGA方案中被认为重要的因素以及可能影响荧光强度的因素鲜有报道。体外实验表明，荧光强度与剂量、工作距离、角度、穿透深度和环境光显著相关。本研究确定了显著影响ICGA荧光强度的因素。应用重量调整的ICG剂量似乎比固定剂量更可取，提倡推荐的工作距离，并且ICGA期间成像头应定位在60°至90°的角度，而不会显著影响荧光强度。在重建皮瓣手术中使用ICGA进行组织灌注评估时，所有这些因素都应予以考虑并报告。
