AB142. SOH24AB_154. Clinical efficacy and cost-effectiveness of intraoperative flap perfusion assessment with indocyanine green angiography in plastic and reconstructive surgery: a systematic review and meta-analysis
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AB142. SOH24AB_154. Clinical efficacy and cost-effectiveness of intraoperative flap perfusion assessment with indocyanine green angiography in plastic and reconstructive surgery: a systematic review and meta-analysis

Ashokkumar Singaravelu1, Cathleen McCarrick2, Shirley Potter3, Ronan Cahill2

1School of Medicine, University College Dublin, Belfield, Dublin, Ireland; 2Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland; 3Department of Plastic and Reconstructive Surgery, Mater Misericordiae University Hospital, Dublin, Ireland

Background: Indocyanine green angiography (ICGA) has gained popularity in plastic and reconstructive procedures to assess flap perfusion intraoperatively. This study aims to investigate the clinical efficacy and cost-effectiveness of incorporating ICGA in diverse plastic and reconstructive surgery scenarios.

Methods: A systematic review was performed according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines for studies utilising ICGA in flap perfusion assessment versus clinical assessment. Data reporting perfusion-related complications were extracted for meta-analysis.

Results: Twenty-two eligible studies were included. ICGA was predominantly performed in breast surgeries (n=2,278) and head and neck (n=701). In breast, the meta-analysis revealed a statistically significant decrease in mastectomy skin flap necrosis [odds ratio (OR): 0.59, 95% confidence interval (CI): 0.45–0.77, P<0.01], fat necrosis (OR: 0.31, 95% CI: 0.16–0.58, P<0.01) and re-operation (OR: 0.39, 95% CI: 0.26–0.60, P<0.01), but no significant decrease in total flap loss (OR: 0.78, 95% CI: 0.33–1.84, P=0.57), partial flap loss (OR: 0.87, 95% CI: 0.56–1.37, P=0.56), and increase in dehiscence (OR: 1.44, 95% CI: 0.82–2.52, P=0.16). In head and neck, the meta-analysis revealed a statistically significant decrease in total flap loss (OR: 0.47, 95% CI: 0.23–0.97, P<0.05), but no significant decrease in partial flap loss (OR: 0.37, 95% CI: 0.10–1.35, P=0.13) and reoperation (OR: 0.92, 95% CI: 0.58–1.46, P=0.73). Seven studies showed cost savings in flap surgery and breast reconstruction.

Conclusions: ICGA is a reliable cost-effective tool to identify hypoperfusion and significantly decreases the rate of fat necrosis in breast and total flap loss in head and neck reconstruction. Further randomized controlled trials are essential to solidify these promising findings.

Keywords: Fluorescence angiography; indocyanine green; meta-analysis; plastic surgery; reconstructive surgery

Acknowledgments

Funding: None.

Footnote

Conflicts of Interest: The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

doi: 10.21037/map-24-ab142
Cite this abstract as: Singaravelu A, McCarrick C, Potter S, Cahill R. AB142. SOH24AB_154. Clinical efficacy and cost-effectiveness of intraoperative flap perfusion assessment with indocyanine green angiography in plastic and reconstructive surgery: a systematic review and meta-analysis. Mesentery Peritoneum 2024;8:AB142.

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