Delphi survey of intercontinental experts to identify areas of consensus on the use of indocyanine green angiography for tissue perfusion assessment during plastic and reconstructive surgery

Rutger M Schols; Fernando Dip; Emanuele Lo Menzo; Nicholas T Haddock; Luis Landin; Bernard T Lee; Paloma Malagón; Jaume Masia; David W Mathes; Maurice Y Nahabedian; Peter C Neligan; Martin I Newman; Brett T Phillips; Gemma Pons; Tim Pruimboom; Shan Shan Qiu; Lucas M Ritschl; Warren M Rozen; Michael Saint-Cyr; Seung Yong Song; René R W J van der Hulst; Mark L Venturi; Apinut Wongkietkachorn; Takumi Yamamoto; Kevin P White; Raul J Rosenthal

doi:10.1016/j.surg.2022.04.015

Delphi survey of intercontinental experts to identify areas of consensus on the use of indocyanine green angiography for tissue perfusion assessment during plastic and reconstructive surgery

Rutger M Schols, Fernando Dip^*, Emanuele Lo Menzo, Nicholas T Haddock, Luis Landin, Bernard T Lee, Paloma Malagón, Jaume Masia, David W Mathes, Maurice Y Nahabedian, Peter C Neligan, Martin I Newman, Brett T Phillips, Gemma Pons, Tim Pruimboom, Shan Shan Qiu, Lucas M Ritschl, Warren M Rozen, Michael Saint-Cyr, Seung Yong SongRené R W J van der Hulst, Mark L Venturi, Apinut Wongkietkachorn, Takumi Yamamoto, Kevin P White, Raul J Rosenthal

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: In recent years, indocyanine green angiography (ICG-A) has been used increasingly to assist tissue perfusion assessments during plastic and reconstructive surgery procedures, but no guidelines exist regarding its use. We sought to identify areas of consensus and non-consensus among international experts on the use of ICG-A for tissue-perfusion assessments during plastic and reconstructive surgery.

METHODS: A two-round, online Delphi survey was conducted of 22 international experts from four continents asking them to vote on 79 statements divided into five modules: module 1 = patient preparation and contraindications (n = 11 statements); module 2 = ICG administration and camera settings (n = 17); module 3 = other factors impacting perfusion assessments (n = 10); module 4 = specific indications, including trauma debridement (n = 9), mastectomy skin flaps (n = 6), and free flap reconstruction (n = 8); and module 5 = general advantages and disadvantages, training, insurance coverage issues, and future directions (n = 18). Consensus was defined as ≥70% inter-voter agreement.

RESULTS: Consensus was reached on 73/79 statements, including the overall value, advantages, and limitations of ICG-A in numerous surgical settings; also, on the dose (0.05 mg/kg) and timing of ICG administration (∼20-60 seconds preassessment) and best camera angle (61-90o) and target-to-tissue distance (20-30 cm). However, consensus also was reached that camera angle and distance can vary, depending on the make of camera, and that further research is necessary to technically optimize this imaging tool. The experts also agreed that ambient light, patient body temperature, and vasopressor use impact perfusion assessments.

CONCLUSION: ICG-A aids perfusion assessments during plastic and reconstructive surgery and should no longer be considered experimental. It has become an important surgical tool.

Original language	English
Pages (from-to)	S46-S53
Number of pages	8
Journal	Surgery
Volume	172
Issue number	6
DOIs	https://doi.org/10.1016/j.surg.2022.04.015
Publication status	Published - Dec 2022

Keywords

Humans
Female
Indocyanine Green
Breast Neoplasms
Mastectomy
Reconstructive Surgical Procedures/methods
Angiography/methods
Perfusion

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10.1016/j.surg.2022.04.015Licence: CC BY-NC-ND

Cite this

Schols, R. M., Dip, F., Lo Menzo, E., Haddock, N. T., Landin, L., Lee, B. T., Malagón, P., Masia, J., Mathes, D. W., Nahabedian, M. Y., Neligan, P. C., Newman, M. I., Phillips, B. T., Pons, G., Pruimboom, T., Qiu, S. S., Ritschl, L. M., Rozen, W. M., Saint-Cyr, M., ... Rosenthal, R. J. (2022). Delphi survey of intercontinental experts to identify areas of consensus on the use of indocyanine green angiography for tissue perfusion assessment during plastic and reconstructive surgery. Surgery, 172(6), S46-S53. https://doi.org/10.1016/j.surg.2022.04.015

@article{1a489ed923ee4ef88ecb8e081761d981,

title = "Delphi survey of intercontinental experts to identify areas of consensus on the use of indocyanine green angiography for tissue perfusion assessment during plastic and reconstructive surgery",

abstract = "BACKGROUND: In recent years, indocyanine green angiography (ICG-A) has been used increasingly to assist tissue perfusion assessments during plastic and reconstructive surgery procedures, but no guidelines exist regarding its use. We sought to identify areas of consensus and non-consensus among international experts on the use of ICG-A for tissue-perfusion assessments during plastic and reconstructive surgery.METHODS: A two-round, online Delphi survey was conducted of 22 international experts from four continents asking them to vote on 79 statements divided into five modules: module 1 = patient preparation and contraindications (n = 11 statements); module 2 = ICG administration and camera settings (n = 17); module 3 = other factors impacting perfusion assessments (n = 10); module 4 = specific indications, including trauma debridement (n = 9), mastectomy skin flaps (n = 6), and free flap reconstruction (n = 8); and module 5 = general advantages and disadvantages, training, insurance coverage issues, and future directions (n = 18). Consensus was defined as ≥70% inter-voter agreement.RESULTS: Consensus was reached on 73/79 statements, including the overall value, advantages, and limitations of ICG-A in numerous surgical settings; also, on the dose (0.05 mg/kg) and timing of ICG administration (∼20-60 seconds preassessment) and best camera angle (61-90o) and target-to-tissue distance (20-30 cm). However, consensus also was reached that camera angle and distance can vary, depending on the make of camera, and that further research is necessary to technically optimize this imaging tool. The experts also agreed that ambient light, patient body temperature, and vasopressor use impact perfusion assessments.CONCLUSION: ICG-A aids perfusion assessments during plastic and reconstructive surgery and should no longer be considered experimental. It has become an important surgical tool.",

keywords = "Humans, Female, Indocyanine Green, Breast Neoplasms, Mastectomy, Reconstructive Surgical Procedures/methods, Angiography/methods, Perfusion",

author = "Schols, {Rutger M} and Fernando Dip and {Lo Menzo}, Emanuele and Haddock, {Nicholas T} and Luis Landin and Lee, {Bernard T} and Paloma Malag{\'o}n and Jaume Masia and Mathes, {David W} and Nahabedian, {Maurice Y} and Neligan, {Peter C} and Newman, {Martin I} and Phillips, {Brett T} and Gemma Pons and Tim Pruimboom and Qiu, {Shan Shan} and Ritschl, {Lucas M} and Rozen, {Warren M} and Michael Saint-Cyr and Song, {Seung Yong} and {van der Hulst}, {Ren{\'e} R W J} and Venturi, {Mark L} and Apinut Wongkietkachorn and Takumi Yamamoto and White, {Kevin P} and Rosenthal, {Raul J}",

year = "2022",

month = dec,

doi = "10.1016/j.surg.2022.04.015",

language = "English",

volume = "172",

pages = "S46--S53",

journal = "Surgery",

issn = "0039-6060",

publisher = "MOSBY-ELSEVIER",

number = "6",

}

Schols, RM, Dip, F, Lo Menzo, E, Haddock, NT, Landin, L, Lee, BT, Malagón, P, Masia, J, Mathes, DW, Nahabedian, MY, Neligan, PC, Newman, MI, Phillips, BT, Pons, G, Pruimboom, T , Qiu, SS, Ritschl, LM, Rozen, WM, Saint-Cyr, M, Song, SY, van der Hulst, RRWJ, Venturi, ML, Wongkietkachorn, A, Yamamoto, T, White, KP & Rosenthal, RJ 2022, 'Delphi survey of intercontinental experts to identify areas of consensus on the use of indocyanine green angiography for tissue perfusion assessment during plastic and reconstructive surgery', Surgery, vol. 172, no. 6, pp. S46-S53. https://doi.org/10.1016/j.surg.2022.04.015

Delphi survey of intercontinental experts to identify areas of consensus on the use of indocyanine green angiography for tissue perfusion assessment during plastic and reconstructive surgery. / Schols, Rutger M; Dip, Fernando; Lo Menzo, Emanuele et al.
In: Surgery, Vol. 172, No. 6, 12.2022, p. S46-S53.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Delphi survey of intercontinental experts to identify areas of consensus on the use of indocyanine green angiography for tissue perfusion assessment during plastic and reconstructive surgery

AU - Schols, Rutger M

AU - Dip, Fernando

AU - Lo Menzo, Emanuele

AU - Haddock, Nicholas T

AU - Landin, Luis

AU - Lee, Bernard T

AU - Malagón, Paloma

AU - Masia, Jaume

AU - Mathes, David W

AU - Nahabedian, Maurice Y

AU - Neligan, Peter C

AU - Newman, Martin I

AU - Phillips, Brett T

AU - Pons, Gemma

AU - Pruimboom, Tim

AU - Qiu, Shan Shan

AU - Ritschl, Lucas M

AU - Rozen, Warren M

AU - Saint-Cyr, Michael

AU - Song, Seung Yong

AU - van der Hulst, René R W J

AU - Venturi, Mark L

AU - Wongkietkachorn, Apinut

AU - Yamamoto, Takumi

AU - White, Kevin P

AU - Rosenthal, Raul J

PY - 2022/12

Y1 - 2022/12

N2 - BACKGROUND: In recent years, indocyanine green angiography (ICG-A) has been used increasingly to assist tissue perfusion assessments during plastic and reconstructive surgery procedures, but no guidelines exist regarding its use. We sought to identify areas of consensus and non-consensus among international experts on the use of ICG-A for tissue-perfusion assessments during plastic and reconstructive surgery.METHODS: A two-round, online Delphi survey was conducted of 22 international experts from four continents asking them to vote on 79 statements divided into five modules: module 1 = patient preparation and contraindications (n = 11 statements); module 2 = ICG administration and camera settings (n = 17); module 3 = other factors impacting perfusion assessments (n = 10); module 4 = specific indications, including trauma debridement (n = 9), mastectomy skin flaps (n = 6), and free flap reconstruction (n = 8); and module 5 = general advantages and disadvantages, training, insurance coverage issues, and future directions (n = 18). Consensus was defined as ≥70% inter-voter agreement.RESULTS: Consensus was reached on 73/79 statements, including the overall value, advantages, and limitations of ICG-A in numerous surgical settings; also, on the dose (0.05 mg/kg) and timing of ICG administration (∼20-60 seconds preassessment) and best camera angle (61-90o) and target-to-tissue distance (20-30 cm). However, consensus also was reached that camera angle and distance can vary, depending on the make of camera, and that further research is necessary to technically optimize this imaging tool. The experts also agreed that ambient light, patient body temperature, and vasopressor use impact perfusion assessments.CONCLUSION: ICG-A aids perfusion assessments during plastic and reconstructive surgery and should no longer be considered experimental. It has become an important surgical tool.

AB - BACKGROUND: In recent years, indocyanine green angiography (ICG-A) has been used increasingly to assist tissue perfusion assessments during plastic and reconstructive surgery procedures, but no guidelines exist regarding its use. We sought to identify areas of consensus and non-consensus among international experts on the use of ICG-A for tissue-perfusion assessments during plastic and reconstructive surgery.METHODS: A two-round, online Delphi survey was conducted of 22 international experts from four continents asking them to vote on 79 statements divided into five modules: module 1 = patient preparation and contraindications (n = 11 statements); module 2 = ICG administration and camera settings (n = 17); module 3 = other factors impacting perfusion assessments (n = 10); module 4 = specific indications, including trauma debridement (n = 9), mastectomy skin flaps (n = 6), and free flap reconstruction (n = 8); and module 5 = general advantages and disadvantages, training, insurance coverage issues, and future directions (n = 18). Consensus was defined as ≥70% inter-voter agreement.RESULTS: Consensus was reached on 73/79 statements, including the overall value, advantages, and limitations of ICG-A in numerous surgical settings; also, on the dose (0.05 mg/kg) and timing of ICG administration (∼20-60 seconds preassessment) and best camera angle (61-90o) and target-to-tissue distance (20-30 cm). However, consensus also was reached that camera angle and distance can vary, depending on the make of camera, and that further research is necessary to technically optimize this imaging tool. The experts also agreed that ambient light, patient body temperature, and vasopressor use impact perfusion assessments.CONCLUSION: ICG-A aids perfusion assessments during plastic and reconstructive surgery and should no longer be considered experimental. It has become an important surgical tool.

KW - Humans

KW - Female

KW - Indocyanine Green

KW - Breast Neoplasms

KW - Mastectomy

KW - Reconstructive Surgical Procedures/methods

KW - Angiography/methods

KW - Perfusion

U2 - 10.1016/j.surg.2022.04.015

DO - 10.1016/j.surg.2022.04.015

M3 - Article

C2 - 36427930

SN - 0039-6060

VL - 172

SP - S46-S53

JO - Surgery

JF - Surgery

IS - 6

ER -