The role of indocyanine green fluorescence angiography in head and neck reconstruction: a systematic review
Research article published in Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery (2026)
Abstract
This systematic review examined the use of Indocyanine Green Fluorescence Angiography (ICG-FA) to evaluate flap viability in reconstructive head and neck surgery. PUBMED, Embase, and Cochrane Library were systematically reviewed. Key outcomes assessed were feasibility of intraoperative ICG-FA, intraoperative alterations, postoperative monitoring, and the predictive value of ICG-FA for flap viability. Fourteen observational cohort studies were included (total n = 1826). ICG-FA was integrated into surgical workflows with minimal disruptions. It helped guide intraoperative alterations and decisions, such as flap design and re-anastomosis. For postoperative monitoring, ICG-FA supported early detection of perfusion deficits, enabling timely interventions. Quantitative perfusion thresholds for impaired viability were mostly relative, ranging from 20% to 50% fluorescence reduction compared to reference areas, derived either retrospectively or based on predefined cutoffs. ICG-FA appears to be a feasible tool for real-time perfusion assessment in head and neck reconstruction. However, the evidence its clinical applicability remains limited by methodological heterogeneity and a serious risk of bias in a proportion of the included studies. Standardization of protocols and prospective validation are needed to enhance clinical application.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Peer-reviewed clinical and outcomes research relevant to medicinal leech therapy and its biology. Indexed in PubMed and verified against the NCBI record.
Why This Matters for Hirudotherapy
This systematic review of 14 observational cohort studies (total n=1826) assessed indocyanine green fluorescence angiography (ICG-FA) for evaluating flap perfusion in head-and-neck reconstruction, reporting that it integrated into surgical workflows with minimal disruption, guided intraoperative decisions such as flap design and re-anastomosis, and supported early postoperative detection of perfusion deficits, with impaired-viability thresholds typically defined as a relative 20-50% fluorescence reduction. This is directly pertinent to the clinical territory where medicinal leech therapy lives: the same perfusion failure and venous congestion that ICG-FA aims to detect early are the conditions that prompt adjunctive leeching to relieve congestion and rescue a failing flap, so improved perfusion monitoring complements, and could help triage candidates for, leech-based salvage. The caveat is that the review's authors flag limited clinical applicability due to methodological heterogeneity and serious risk of bias in some included studies, and that it concerns an imaging-based monitoring tool, not hirudotherapy; it does not evaluate leech therapy and so informs the flap-monitoring context only, pending the standardization and prospective validation the authors call for.
Citation
The role of indocyanine green fluorescence angiography in head and neck reconstruction: a systematic review.
Poen et al. · Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery, 2026
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