Clinical and Cost-Effectiveness of Intraoperative Flap Perfusion Assessment With Indocyanine Green Fluorescence Angiography in Breast and Head and Neck Reconstructions: A Systematic Review and Meta-Analysis

IF 1.5 3区医学 Q3 SURGERY Microsurgery Pub Date : 2024-10-24 DOI:10.1002/micr.31250

Ashokkumar Singaravelu, Cathleen McCarrick, Shirley Potter, Ronan A. Cahill

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Abstract

Background

Indocyanine green fluorescence angiography (ICGFA) is gaining popularity for the assessment of reconstructive flap perfusion intraoperatively. This study analyses the literature with a focus on its clinical efficacy and cost-effectiveness across various plastic and reconstructive surgery procedures.

Methods

A systematic review was conducted in accordance with PRISMA guidelines on published studies in English comparing ICGFA with standard clinical assessment for flap perfusion. Meta-analysis concerned perfusion-related complications and cost data.

Results

Twenty-five studies met the inclusion criteria, of which two were randomized controlled trials (RCTs) and four were prospective cohort studies. Twenty-one studies were AHRQ Standard ‘Good’; however, the overall level of evidence remains low. ICGFA was predominantly performed in breast surgeries (n = 3310) and head and neck reconstruction (n = 701) albeit with inconsistency in protocols and predominantly subjective interpretations (only five studies utilized objective thresholds). In breast surgery, meta-analysis demonstrated significant reductions in mastectomy skin flap necrosis (odds ratio (OR) 0.58, p < 0.0001), fat necrosis (OR 0.31, p < 0.001), infection (OR 0.66, p = 0.02), and re-operation (OR 0.40, p < 0.0001), but no significant decrease in total or partial flap loss (OR 0.78, p = 0.57/OR 0.87, p = 0.56, respectively) or increase in dehiscence (OR 1.55, p = 0.11). In head and neck surgery, ICGFA significantly decreased total flap loss (OR 0.47, p = 0.04), although not partial flap loss (OR 0.37, p = 0.13) and reoperation (OR 0.92, p = 0.73). Lower limb (n = 104) and abdominal wall (n = 95) reconstructive surgeries were much less studied with no significant ICGFA impact. Seven studies reported cost savings with flap surgeries and breast reconstructions, although study heterogeneity precluded meta-analysis.

Conclusions

ICGFA appears to be a useful, cost-effective tool to identify otherwise unsuspected hypoperfusion in breast and head and neck reconstruction. There is a clear need for standardization, however, to avoid bias. Further RCTs are necessary to solidify these promising clinical findings.

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在乳房和头颈部重建中使用吲哚青绿荧光血管造影术进行术中皮瓣灌注评估的临床和成本效益：系统综述与元分析》。

背景：吲哚菁绿荧光血管造影术（ICGFA）在术中评估重建皮瓣灌注方面越来越受欢迎。本研究分析了相关文献，重点关注其在各种整形和重建手术中的临床疗效和成本效益：方法：根据 PRISMA 指南，对已发表的英文研究进行了系统性回顾，比较了 ICGFA 与皮瓣灌注标准临床评估。结果：25 项研究符合纳入标准：25项研究符合纳入标准，其中2项为随机对照试验（RCT），4项为前瞻性队列研究。其中 21 项研究达到了美国卫生与质量管理局的 "良好 "标准，但总体证据水平仍然较低。ICGFA 主要用于乳房手术（n = 3310）和头颈部重建（n = 701），尽管方案不一致，而且主要是主观解释（只有五项研究使用了客观阈值）。在乳房手术中，荟萃分析表明乳房切除术皮瓣坏死率显著降低（几率比（OR）0.58，P 结论：ICGFA 似乎是一种有用的方法：ICGFA 似乎是一种有用且经济有效的工具，可用于识别乳房和头颈部重建中原本未被察觉的灌注不足。但是，为了避免偏差，显然需要标准化。有必要进一步开展研究性试验，以巩固这些有前景的临床研究结果。

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来源期刊

Microsurgery 医学-外科

CiteScore

3.80

自引率

19.00%

发文量

128

审稿时长

4-8 weeks

期刊介绍： Microsurgery is an international and interdisciplinary publication of original contributions concerning surgery under microscopic magnification. Microsurgery publishes clinical studies, research papers, invited articles, relevant reviews, and other scholarly works from all related fields including orthopaedic surgery, otolaryngology, pediatric surgery, plastic surgery, urology, and vascular surgery.