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Review
. 2022 Jan 21;12(2):154.
doi: 10.3390/life12020154.

Near-Infrared Fluorescence with Indocyanine Green to Assess Bone Perfusion: A Systematic Review

Marlies Michi  1 , Max Madu  2 , Henri A H Winters  2 , Daniel M de Bruin  3   4 , Joost R van der Vorst  5 , Caroline Driessen  2
Affiliations
Review

Near-Infrared Fluorescence with Indocyanine Green to Assess Bone Perfusion: A Systematic Review

Marlies Michi et al. Life (Basel). .

Abstract

Background: Adequate perfusion of a bone flap is essential for successful reconstruction of osseous defects. Unfortunately, complications related to inadequate bone perfusion are common. Near-infrared fluorescence (NIRF) imaging enables intraoperative visualization of perfusion. NIRF has been investigated in reconstructive surgery to aid the surgeon in clinical perioperative assessment of soft tissue perfusion. However, little is known on the beneficial use of NIRF to assess bone perfusion. Therefore, the aim of this review was to search for studies evaluating NIRF to assess bone perfusion. Methods: A systematic review, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, was performed. Studies up to October 2021 were included. We extracted data regarding the study population, size and design, reported objective fluorescence parameters and the methodology used for fluorescence imaging and processing. Results: Ten articles were included. Studies reported unevenly on the protocol used for NIRF imaging. Five studies reported objective parameters. Absolute and relative perfusion parameters and parameters derived from maximum fluorescence were reported. The clinical significance of these parameters has not been evaluated in humans. Conclusion: The evidence on bone perfusion as measured with NIRF is limited. More clinical studies are required.

Keywords: bone perfusion; indocyanine green; near-infrared fluorescence.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Perioperative photo of a patient who has a viable rectus femoris muscle flap (red inset) in a tibia after debridement of osteomyelitis. Because of ongoing infection and a PET scan suspicious for necrotic bone another surgical debridement was performed. Fluorescence imaging confirmed a lack of signal at a specific tibia region (blue inset) which was removed.
Figure 2
Figure 2
Flowchart of inclusion.
Figure 3
Figure 3
ICG fluorescence map overlay on the white light images of a porcine tibia from the study of Gitajn et al. p2 and d2 are, respectively the proximal and distal region of interest of the tibia. The fluorescence imaging had been enhanced for better visualization.
See this image and copyright information in PMC

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