The role of indocyanine green fluorescence angiography in head and neck reconstruction: a systematic review

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.

Resumen tomado de PubMed (NCBI) para el registro citado, en el idioma original. La versión de referencia es la de la publicación original.

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Systematic review of 14 observational cohort studies (total n=1826) found indocyanine green fluorescence angiography feasible for intraoperative and postoperative flap perfusion assessment in head and neck reconstruction, though evidence remains limited by heterogeneity and bias risk.

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