Delphi survey of intercontinental experts to identify areas of consensus on the use of indocyanine green angiography for tissue perfusion assessment during plastic and reconstructive surgery
Por:
Schols R.M., Dip F., Lo Menzo E., Haddock N.T., Landin L., Lee B.T., Malagón P., Masia J., Mathes D.W., Nahabedian M.Y., Neligan P.C., Newman M.I., Phillips B.T., Pons G., Pruimboom T., Qiu S.S., Ritschl L.M., Rozen W.M., Saint-Cyr M., Song S.Y., van der Hulst R.R.W.J., Venturi M.L., Wongkietkachorn A., Yamamoto T., White K.P., Rosenthal R.J.
Publicada:
1 ene 2022
Resumen:
Background: In recent years, indocyanine green angiography (ICG-A) has been used increasingly to assist tissue perfusion assessments during plastic and reconstructive surgery procedures, but no guidelines exist regarding its use. We sought to identify areas of consensus and non-consensus among international experts on the use of ICG-A for tissue-perfusion assessments during plastic and reconstructive surgery. Methods: A two-round, online Delphi survey was conducted of 22 international experts from four continents asking them to vote on 79 statements divided into five modules: module 1 = patient preparation and contraindications (n = 11 statements); module 2 = ICG administration and camera settings (n = 17); module 3 = other factors impacting perfusion assessments (n = 10); module 4 = specific indications, including trauma debridement (n = 9), mastectomy skin flaps (n = 6), and free flap reconstruction (n = 8); and module 5 = general advantages and disadvantages, training, insurance coverage issues, and future directions (n = 18). Consensus was defined as =70% inter-voter agreement. Results: Consensus was reached on 73/79 statements, including the overall value, advantages, and limitations of ICG-A in numerous surgical settings; also, on the dose (0.05 mg/kg) and timing of ICG administration (~20–60 seconds preassessment) and best camera angle (61-90o) and target-to-tissue distance (20–30 cm). However, consensus also was reached that camera angle and distance can vary, depending on the make of camera, and that further research is necessary to technically optimize this imaging tool. The experts also agreed that ambient light, patient body temperature, and vasopressor use impact perfusion assessments. Conclusion: ICG-A aids perfusion assessments during plastic and reconstructive surgery and should no longer be considered experimental. It has become an important surgical tool. © 2022 The Authors
Filiaciones:
Schols R.M.:
Maastricht University Medical Center, Masstricht, Netherlands
Dip F.:
Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
Lo Menzo E.:
Cleveland Clinic Florida, Weston, FL
Haddock N.T.:
University of Texas Southwestern Medical Center, Dallas, TX
Landin L.:
FIBHULP/IdiPaz, Hospital Universitario La Paz, Madrid., Spain
Lee B.T.:
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
Malagón P.:
Hospital Germans Trias i Pujol, Barcelona, Badalona, Spain
Masia J.:
Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Mathes D.W.:
University of Colorado, Aurora, CO
Nahabedian M.Y.:
Center for Plastic Surgery, McLean, VA, United States
Neligan P.C.:
University of Washington, Seattle, WA, United States
Newman M.I.:
Cleveland Clinic Florida, Weston, FL
Phillips B.T.:
Duke University Hospital, Durham, NC
Pons G.:
Hospital de la Santa Creu, Barcelona, Spain
Pruimboom T.:
Maastricht University Medical Center, Masstricht, Netherlands
Qiu S.S.:
Maastricht University Medical Center, Masstricht, Netherlands
Ritschl L.M.:
Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
Rozen W.M.:
Monash University, Peninsula Campus, Frankston Victoria, Australia
Saint-Cyr M.:
MD Anderson Cancer Center, Phoenix, AZ
Song S.Y.:
Yonsei University College of Medicine, Seoul, South Korea
van der Hulst R.R.W.J.:
Maastricht University Medical Center, Masstricht, Netherlands
Venturi M.L.:
VCU School of Medicine INOVA, National Center for Plastic Surgery, Washington, DC
Wongkietkachorn A.:
Mae Fah Luang University, Bangkok, Thailand
Yamamoto T.:
National Center for Global Health and Medicine, Tokyo, Japan
White K.P.:
ScienceRight Research Consulting Services, London, ON, Canada
Rosenthal R.J.:
Cleveland Clinic Florida, Weston, FL
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