Table 5. Summary of all clinical studies reporting the utility of ICG in detecting flap and fat necrosis in autologous breast reconstructions.
| Author | Year | Type | Auto | Patient | Control | P/R | Device | Rate of necrosis (%) | Findings |
|---|---|---|---|---|---|---|---|---|---|
| Duggal (94) | 2014 | TRAM | 71 | N/A | 59 | R | SPY | 10 | ICG-guided excision showed a trend in the reduction of TRAM flap necrosis (14% vs. 22%, P=0.237) and flap loss (1.4% vs. 3.4%, P=1.00) |
| Wu (131) | 2013 | TRAM, DIEP | N/A | 17 | N/A | R | SPY | 7 | Overestimation of perfusion 7% |
| Underestimation of perfusion 7% | |||||||||
| ICG may be more unreliable in patients with dark skin (overestimation of 22% and underestimation of 22%) | |||||||||
| Komorowska-Timek (33) | 2010 | TRAM, DIEP, SIEA, LD | 8 | 8 | 148 | P | SPY | 4 | 1 case of partial necrosis occurred reconstruction with LD flap and tissue expander where ICG detected subclinical hypoperfusion |
| Francisco (124) | 2010 | DIEP | 5 | N/A | N/A | R | SPY | 0 | ICG is useful for perforator selection, SIEA assessment, microvascular anastomosis patency assessment, and flap perfusion assessment |
| Jones (132) | 2009 | TRAM, DIEP, LD | 64 | 43 | N/A | R | SPY | 6.3 | ICG correlated 100% with areas of necrosis |
| Newman (34) | 2009 | TRAM,DIEP | 10 | 8 | N/A | P | SPY | N/A | 3 out of 4 flaps showing poor perfusion by ICG were improved by intraoperative adjustments |
| 1 out of 4 flaps showing poor perfusion by ICG was not adjusted intraoperatively and required re-exploration | |||||||||
| Pestana (35) | 2009 | TRAM, DIEP, SGAP, SIEA, TUG | 12 | 10 | N/A | R | SPY | 8 | ICG is safe and requires minimal additional operative time and general anesthesia |
| Yamaguchi (133) | 2004 | TRAM | 10 | 10 | N/A | R | IC-View | 40 | ICG accurately predicted 3 out 4 cases of partial necrosis |
ICG, indocyanine green; auto, number of autologous breast reconstructions; P, prospective; R, retrospective; TRAM, transverse rectus abdominis muscle; LD, latissimus dorsi; DIEP, deep inferior epigastric artery perforator; SIEA, superficial inferior epigastric artery; SGAP, superior gluteal artery perforator; TUG, transverse upper gracilis.