Evaluation of Online Educational Content on Indocyanine Green Fluorescence for Flap Perfusion: Assessment of Quality, Reliability, and Engagement Metrics

Introduction: Indocyanine green (ICG) fluorescence angiography is widely implemented for flap perfusion assessment. YouTube is commonly used for procedural learning despite variable educational rigor. This study evaluated the quality and reliability of YouTube videos on ICG-assisted flap perfusion and examined whether popularity metrics reflect educational value. Methods: Videos were systematically identified and assessed using the Global Quality Score, modified DISCERN, and a procedure-specific Medical Content Index. Popularity metrics included views per day, like ratio and video power index. Results: Twenty-nine videos were included. Perceived quality was generally high, but reliability and content completeness varied. Popularity metrics were strongly intercorrelated but did not correlate with overall educational quality. Higher like ratio was associated with greater reliability and completeness, whereas higher views per day predicted lower reliability. Conclusions: Viewer engagement metrics do not reliably indicate educational quality of YouTube content on ICG-assisted flap perfusion. Peer-informed standards are needed for online surgical education. (c) 2026 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.