An Analysis of Current Techniques Used for Intraoperative Flap Evaluation

Area of Science:

• Medical technology
• Microsurgery
• Vascular surgery

Background:

• Microsurgeons are utilizing increasingly complex flaps and adopting new technologies for planning and monitoring.
• Technologies like indocyanine green (ICG) angiography, dynamic infrared thermography (DIRT), and photospectrometry are transitioning into the operating room.
• These tools aim to optimize flap design and detect perfusion issues or anastomotic problems, but their intraoperative role requires further clarification.

Purpose of the Study:

• To systematically analyze intraoperative applications of ICG angiography, DIRT, and photospectrometry.
• To define the sensitivity, specificity, outcomes, and potential complications of these intraoperative techniques.

Main Methods:

• Systematic literature review of studies employing intraoperative ICG angiography, DIRT, and photospectrometry.
• Analysis focused on quantifying diagnostic performance metrics.

Main Results:

• Intraoperative ICG angiography demonstrated high sensitivity (90.9%) and accuracy (98.6%).
• DIRT showed lower sensitivity (33%) but high specificity (100%) and 80% accuracy.
• Photospectrometry exhibited high sensitivity (92%) and perfect specificity (100%) and accuracy (100%).

Conclusions:

• Intraoperative perfusion assessment technologies offer objective data to enhance flap design and microvascular anastomosis quality.
• Further investigation is necessary to fully establish the clinical value of these emerging techniques.