First clinical applications for the NIR-II imaging with ICG in microsurgery

Area of Science:

• Medical Imaging
• Microsurgery
• Optical Imaging

Background:

• Accurate identification of blood supply is crucial but challenging in microsurgery.
• Existing methods for vascular visualization in procedures like flap transplantation have limitations.
• Near-infrared window I (NIR-I) imaging is widely used, but near-infrared window II (NIR-II) imaging offers superior penetration and noninvasive characteristics.

Purpose of the Study:

• To evaluate the utility of a portable NIR-II imaging system with indocyanine green (ICG) in enhancing microsurgical operations.
• To assess the system's effectiveness in visualizing critical vascular structures and guiding surgical decisions.
• To determine if NIR-II imaging can improve the safety and efficiency of microsurgical procedures.

Main Methods:

• A portable NIR-II imaging instrument was employed in conjunction with intravenous injection of FDA-approved indocyanine green (ICG).
• The system was utilized in 39 patients undergoing various microsurgical procedures, including vascular anastomosis and flap transplantation.
• Visualization of anastomotic vessels, salvaged distal limbs, and perforator vessels was assessed.

Main Results:

• ICG injection enabled clear visualization of anastomotic vessels and salvaged distal limbs.
• The NIR-II imaging technique facilitated the identification of perforator vessels and estimation of perforator areas before flap harvesting.
• Post-operative prognosis monitoring was improved using this imaging modality.

Conclusions:

• Portable NIR-II imaging with ICG is a valuable tool for improving operative efficiency and outcomes in microsurgery.
• The technique enhances the safety and accuracy of microsurgical procedures by providing clear intraoperative visualization.
• This approach aids in critical steps such as vessel identification, flap planning, and prognosis assessment.