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

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 inter...

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Detalhes bibliográficos
Autores: Schols R.M., Dip F., Lo Menzo E., Haddock N.T., Landin L., Lee B.T., Malagón P., Masia J., Mathes D.W., Nahabedian M.Y., Neligan P.C., Newman M.I., Phillips B.T., Pons G., Pruimboom T., Qiu S.S., Ritschl L.M., Rozen W.M., Saint-Cyr M., Song S.Y., van der Hulst R.R.W.J., Venturi M.L., Wongkietkachorn A., Yamamoto T., White K.P., Rosenthal R.J.
Tipo de documento: artigo
Estado:Versão publicada
Data de publicação:2022
País:España
Recursos:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
Repositório:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
OAI Identifier:oai:iibsantpau.fundanetsuite.com:p15720
Acesso em linha:https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=15720
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85142940615&doi=10.1016%2fj.surg.2022.04.015&partnerID=40&md5=1a6a5e0508d40687a10f917b377617e6
Access Level:Acceso aberto
Palavra-chave:indocyanine green
angiography
breast tumor
female
human
mastectomy
perfusion
procedures
reconstructive surgery
Angiography
Breast Neoplasms
Female
Humans
Indocyanine Green
Mastectomy
Perfusion
Reconstructive Surgical Procedures
Descrição
Resumo: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. 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. 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 (61-90o) 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. 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. © 2022 The Authors

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