Fluorescence-Guided Surgery for Necrotizing Soft Tissue Infections: A Systematic Review

Necrotizing soft tissue infections are life-threatening infections of soft tissue that are treated with rapid surgical debridement when the diagnosis is suspected. Necrotic tissue is removed until vital tissue is identified, guided by the surgeon's vision and hands. Fluorescence-guided surgery is increasingly popular for assessing tissue perfusion. This surgery may have the potential to improve the diagnosis and treatment of necrotizing soft tissue infections. A systematic review on fluorescence-guided surgery for necrotizing soft tissue infections was conducted according to the PRISMA guidelines and Cochrane methodology. A study protocol was prospectively registered on PROSPERO (registration number: CRD420261348991). A comprehensive search was performed across PubMed, Embase, the Cochrane Library, Scopus, Web of Science, ClinicalTrials.gov, and the WHO Clinical Trials Registry Platform. Furthermore, a bibliographic search of relevant literature was conducted. A total of 2377 records were identified and screened. We identified two case studies, including a total of three patients. Both studies found the technique to be feasible in the surgical debridement of necrotizing soft tissue infections, with no adverse events. The main limitation of this review is the limited literature on fluorescence-guided surgery for necrotizing soft tissue infections identified, with only two case studies included. Both reports showed potential benefits in surgical management; however, further studies are urgently needed. This systematic review found a limited number of studies on indocyanine green (ICG) fluorescence-guided surgery in patients with necrotizing soft tissue infections, and the identified evidence was insufficient to draw firm conclusions. Both reports indicate the method's feasibility, with a potentially greater assessment of tissue perfusion.