Semiquantitative Tissue Perfusion Assessment Using Indocyanine Green in Complex Open Urethral Reconstruction

Area of Science:

• Urology
• Surgical Innovation
• Medical Imaging

Background:

• Current genitourinary reconstruction relies on subjective tissue assessment.
• Intravenous indocyanine green (ICG) fluorescence offers a novel approach for perfusion evaluation.

Discussion:

• ICG enables semiquantitative assessment of graft beds and flaps using near-infrared fluorescence.
• Established perfusion cutoffs (e.g., 60% for graft beds, 40% for flaps) correlate with clinical judgment.
• Real-time perfusion visualization aids in surgical decision-making to prevent ischemia.

Key Insights:

• ICG fluorescence provides objective perfusion data in complex urethral reconstruction.
• Case studies demonstrate ICG's utility in onlay graft urethroplasty, flap assessment, and staged reconstructions.
• The technique supports tailored surgical planning and potentially reduces complications like tissue necrosis.

Outlook:

• Near-infrared fluorescence tools can advance quantitative tissue assessment in genitourinary reconstruction.
• Further research can establish meaningful perfusion thresholds correlating with clinical outcomes.
• ICG fluorescence holds potential to standardize and improve reconstructive surgery techniques.