Outcome prediction in microsurgery by quantitative evaluation of perfusion using ICG fluorescence angiography

The purpose of this prospective study was to evaluate the clinical efficacy of laser-induced fluorescence angiography with indocyanine green (ICG-FA) for perioperative monitoring of tissue perfusion in hand surgery. Different quantitative parameters of the uptake, distribution and clearance of dye-marked blood were evaluated for their sensitivity and prognostic value in comparison to each other and to clinical parameters. One hundred and fifty-five measurements were performed prior to, or following, surgery for severe hand injuries. All quantitative parameters of ICG-FA detected intraoperatively were found to be of significant predictive value for outcome, but clinical parameters were not. For the dye uptake, a minimum slope value of 0.01 was significantly related to sufficient perfusion and good prognosis. There was no correlation between the quantitative ICG-FA results or any of the clinical parameters. Since clinical evaluation of perfusion in this surgery remains difficult, the additional use of ICG-FA may improve surgical decision making and, thereby, lead to better clinical results.