Subjective interpretation of ICG-FA in reconstructive surgery: Perception versus perfusion

Area of Science:

• Plastic Surgery
• Surgical Imaging
• Medical Devices

Background:

• Indocyanine green fluorescence angiography (ICG-FA) provides real-time perfusion visualization in reconstructive surgery.
• Current ICG-FA interpretation is subjective and prone to variability.
• Predicting perfusion-related complications using ICG-FA requires further investigation.

Purpose of the Study:

• To evaluate interobserver variability in ICG-FA interpretation.
• To assess the accuracy of ICG-FA in predicting perfusion-related complications.
• To determine the impact of observer experience on ICG-FA assessment.

Main Methods:

• Thirty ICG-FA videos from reconstructive cases were reviewed by plastic surgery residents and consultants.
• Perfusion was classified as normal, suspicious, or compromised.
• Interobserver agreement was analyzed using Fleiss' Kappa, and a generalized linear mixed model assessed accuracy.

Main Results:

• Moderate overall interobserver agreement (κ = 0.42) was observed, with slightly higher agreement among residents.
• Flap perfusion was significantly less accurately assessed in cases with complications (OR 0.04).
• Observer experience (resident vs. consultant) did not significantly affect assessment accuracy.

Conclusions:

• Subjective interpretation of ICG-FA in reconstructive surgery exhibits significant interobserver variability.
• Visual assessment struggles with subtle perfusion abnormalities and venous outflow disturbances.
• Quantitative ICG-FA approaches may offer improved accuracy and objectivity.