The Role of Indocyanine Green Fluorescence Angiography in Complex Abdominal Wall Reconstruction: A Scoping Review of the Literature

• Published in: Journal of plastic, reconstructive & aesthetic surgery Vol. 75; no. 2; pp. 674 - 682
• Main Authors: Adams, Simon T., West, Christian, Walsh, Ciaran J.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-02-2022
• Subjects: Abdominal Wall - diagnostic imaging; Abdominal Wall - surgery; Abdominal wall reconstruction; Abdominoplasty - methods; Adolescent; Aged; Fluorescein Angiography - methods; Fluorescence angiography; Hernia; Hernia, Ventral - surgery; Humans; ICG; Indocyanine Green; Randomized Controlled Trials as Topic; Retrospective Studies; Hernia; Indocyanine green; Fluorescence angiography; ICG; Abdominal wall reconstruction
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2021.08.048

Indocyanine green fluorescence angiography (ICGFA) is a technique for assessing vascularity and perfusion which has multiple proven applications across a variety of surgical procedures. Studies have been performed assessing its potential role in evaluating skin flap viability in complex abdominal wall reconstruction (CAWR) in order to avoid postoperative surgical site occurrences (SSO).
This scoping review was intended to summarise the literature concerning ICGFA in CAWR in order to facilitate future evidence-based guidelines for its use.
Inclusion – cohort studies, randomised controlled trials, case series, case reports and ventral midline hernias only. Exclusion – patients aged under 18 years and non-human test subjects.
PubMed, MEDLINE®, Cochrane, Embase and OpenGrey
A total of 3416 unique titles were yielded from our search of which 9 met our inclusion criteria: 3 case reports, 1 retrospective case series, 1 prospective case series, 3 non-blinded, non-randomised retrospective case-controlled studies and 1 prospective, double-blinded randomised controlled study. The included studies varied considerably in size and method however the consensus appeared to support ICGFA as being a safe and feasible means of assessing tissue flap vascularity in CAWR. The studies returned contrasting results regarding the impact of ICGFA in predicting and avoiding SSOs however there were insufficient numbers of studies for a meta-analysis.
We identify three case reports and four lower quality studies suggesting a possible application for ICGFA in CAWR and two higher quality studies showing no overall benefit. Evidence-based guidelines on the role of ICGFA in CAWR will require the assessment of further studies.