Back to Search Start Over

Delphi survey of intercontinental experts to identify areas of consensus on the use of indocyanine green angiography for tissue perfusion assessment during plastic and reconstructive surgery.

Authors :
Schols RM
Dip F
Lo Menzo E
Haddock NT
Landin L
Lee BT
Malagón P
Masia J
Mathes DW
Nahabedian MY
Neligan PC
Newman MI
Phillips BT
Pons G
Pruimboom T
Qiu SS
Ritschl LM
Rozen WM
Saint-Cyr M
Song SY
van der Hulst RRWJ
Venturi ML
Wongkietkachorn A
Yamamoto T
White KP
Rosenthal RJ
Source :
Surgery [Surgery] 2022 Dec; Vol. 172 (6S), pp. S46-S53.
Publication Year :
2022

Abstract

Background: In recent years, indocyanine green angiography (ICG-A) has been used increasingly to assist tissue perfusion assessments during plastic and reconstructive surgery procedures, but no guidelines exist regarding its use. We sought to identify areas of consensus and non-consensus among international experts on the use of ICG-A for tissue-perfusion assessments during plastic and reconstructive surgery.<br />Methods: A two-round, online Delphi survey was conducted of 22 international experts from four continents asking them to vote on 79 statements divided into five modules: module 1 = patient preparation and contraindications (n = 11 statements); module 2 = ICG administration and camera settings (n = 17); module 3 = other factors impacting perfusion assessments (n = 10); module 4 = specific indications, including trauma debridement (n = 9), mastectomy skin flaps (n = 6), and free flap reconstruction (n = 8); and module 5 = general advantages and disadvantages, training, insurance coverage issues, and future directions (n = 18). Consensus was defined as ≥70% inter-voter agreement.<br />Results: Consensus was reached on 73/79 statements, including the overall value, advantages, and limitations of ICG-A in numerous surgical settings; also, on the dose (0.05 mg/kg) and timing of ICG administration (∼20-60 seconds preassessment) and best camera angle (61-90 <superscript>o</superscript> ) and target-to-tissue distance (20-30 cm). However, consensus also was reached that camera angle and distance can vary, depending on the make of camera, and that further research is necessary to technically optimize this imaging tool. The experts also agreed that ambient light, patient body temperature, and vasopressor use impact perfusion assessments.<br />Conclusion: ICG-A aids perfusion assessments during plastic and reconstructive surgery and should no longer be considered experimental. It has become an important surgical tool.<br /> (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Details

Language :
English
ISSN :
1532-7361
Volume :
172
Issue :
6S
Database :
MEDLINE
Journal :
Surgery
Publication Type :
Academic Journal
Accession number :
36427930
Full Text :
https://doi.org/10.1016/j.surg.2022.04.015