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
Rutger M. Schols, Fernando Dip, Emanuele Lo Menzo, Nicholas T. Haddock, Luis Landín, Bernard T. Lee, Paloma Malagón, Jaume Masià, David W. Mathes, Maurice Y. Nahabedian, Peter C. Neligan, Martin Newman, Brett T. Phillips, Gemma Pons, Tim Pruimboom, Shan Shan Qiu, Lucas M. Ritschl, Warren M. Rozen, Michael Saint-Cyr, Seung Yong Song, René R. W. J. van der Hulst, Mark L. Venturi, Apinut Wongkietkachorn, Takumi Yamamoto, Kevin P. White, Raúl J. Rosenthal
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. 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: ) 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.