Skip to main content

Advertisement

SpringerLink
Log in

Intraoperative indocyanine green fluorescence angiography to predict wound complications in complex ventral hernia repair

  • Original Article
  • Published:
Hernia Aims and scope Submit manuscript

Abstract

Introduction

Complex ventral hernia repair (VHR) is associated with a greater than 30 % wound complication rate. Perfusion mapping using indocyanine green fluorescence angiography (ICG-FA) has been demonstrated to predict skin and soft tissue necrosis in many reconstructive procedures; however, it has yet to be evaluated in VHR.

Methods

Patients undergoing complex VHR involving component separation and/or extensive subcutaneous advancement flaps were included in a prospective, blinded study. Patients with active infection were excluded. ICG-FA was performed prior to incision and prior to closure, but the surgeon was not allowed to view it. An additional blinded surgeon documented wound complications and evaluated postoperative photographs. The operative ICG-FA was reviewed blinded, and investigators were then unblinded to determine its ability to predict wound complications.

Results

Fifteen consecutive patients were enrolled with mean age of 56.1 years and average BMI of 34.9, of which 60 % were female. Most (73.3 %) had prior hernia repairs (average of 1.8 prior repairs). Mean defect area was 210.4 cm2, mean OR time was 206 min, 66.6 % of patients underwent concomitant panniculectomy, and 40 % had component separation. Mean follow-up was 7 months. Two patients developed wound breakdown requiring reoperation, while 1 had significant fat necrosis and another a wound infection, requiring operative intervention. ICG-FA was objectively reviewed and predicted all 4 wound complications. Of the 12 patients without complications, 1 had an area of low perfusion on ICG-FA. This study found a sensitivity of 100 % and specificity of 90.9 % for predicting wound complications using ICG-FA.

Conclusion

In complex VHR patients, subcutaneous perfusion mapping with ICG-FA is very sensitive and has the potential to reduce cost and improve patient quality of life by reducing wound complications and reoperation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Poulose BK et al (2012) Epidemiology and cost of ventral hernia repair: making the case for hernia research. Hernia 16(2):179–183

    Article  CAS  PubMed  Google Scholar 

  2. Flum DR, Horvath K, Koepsell T (2003) Have outcomes of incisional hernia repair improved with time? A population-based analysis. Ann Surg 237(1):129–135

    Article  PubMed  PubMed Central  Google Scholar 

  3. Ramirez OM, Ruas E, Dellon AL (1990) “Components separation” method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg 86(3):519–526

    Article  CAS  PubMed  Google Scholar 

  4. Albright E et al (2011) The component separation technique for hernia repair: a comparison of open and endoscopic techniques. Am Surg 77(7):839–843

    PubMed  Google Scholar 

  5. Ko JH et al (2009) Abdominal wall reconstruction: lessons learned from 200 “components separation” procedures. Arch Surg 144(11):1047–1055

    Article  PubMed  Google Scholar 

  6. Huger WE Jr (1979) The anatomic rationale for abdominal lipectomy. Am Surg 45(9):612–617

    PubMed  Google Scholar 

  7. Harth KC, Blatnik JA, Rosen MJ (2011) Optimum repair for massive ventral hernias in the morbidly obese patient–is panniculectomy helpful? Am J Surg 201(3):396–400 discussion 400

    Article  PubMed  Google Scholar 

  8. Saxe A et al (2008) Simultaneous panniculectomy and ventral hernia repair following weight reduction after gastric bypass surgery: is it safe? Obes Surg 18(2):192–195 discussion 196

    Article  PubMed  Google Scholar 

  9. Downey SE et al (2005) Review of technique for combined closed incisional hernia repair and panniculectomy status post-open bariatric surgery. Surg Obes Relat Dis 1(5):458–461

    Article  PubMed  Google Scholar 

  10. Leevy CM, Stein SW, Cherrick GR, Davidson CS (1959) Indocyanine green clearence: a test of liver excretory function. Clin Res 7:290–294

    Google Scholar 

  11. Flower RW, Hochheimer BF (1972) Clinical infrared absorption angiography of the choroid. Am J Ophthalmol 73(3):458–459

    Article  CAS  PubMed  Google Scholar 

  12. Eren S et al (1995) Assessment of microcirculation of an axial skin flap using indocyanine green fluorescence angiography. Plast Reconstr Surg 96(7):1636–1649

    Article  CAS  PubMed  Google Scholar 

  13. Rubben A et al (1994) Infrared videoangiofluorography of the skin with indocyanine green–rat random cutaneous flap model and results in man. Microvasc Res 47(2):240–251

    Article  CAS  PubMed  Google Scholar 

  14. Holm C et al (2002) Monitoring free flaps using laser-induced fluorescence of indocyanine green: a preliminary experience. Microsurgery 22(7):278–287

    Article  CAS  PubMed  Google Scholar 

  15. Holm C et al (2002) Intraoperative evaluation of skin-flap viability using laser-induced fluorescence of indocyanine green. Br J Plast Surg 55(8):635–644

    Article  CAS  PubMed  Google Scholar 

  16. Still J et al (1999) Evaluation of the circulation of reconstructive flaps using laser-induced fluorescence of indocyanine green. Ann Plast Surg 42(3):266–274

    Article  CAS  PubMed  Google Scholar 

  17. Desai ND et al (2006) A randomized comparison of intraoperative indocyanine green angiography and transit-time flow measurement to detect technical errors in coronary bypass grafts. J Thorac Cardiovasc Surg 132(3):585–594

    Article  PubMed  Google Scholar 

  18. Takahashi M et al (2004) SPY: an innovative intra-operative imaging system to evaluate graft patency during off-pump coronary artery bypass grafting. Interact Cardiovasc Thorac Surg 3(3):479–483

    Article  PubMed  Google Scholar 

  19. Sanchez EQ et al (2008) Intraoperative imaging of pancreas transplant allografts using indocyanine green with laser fluorescence. Proc (Bayl Univ Med Cent) 21(3):258–260

    PubMed Central  Google Scholar 

  20. Sekijima M et al (2004) An intraoperative fluorescent imaging system in organ transplantation. Transplant Proc 36(7):2188–2190

    Article  CAS  PubMed  Google Scholar 

  21. Stanga PE, Lim JI, Hamilton P (2003) Indocyanine green angiography in chorioretinal diseases: indications and interpretation: an evidence-based update. Ophthalmology 110(1):15–21 quiz 22–3

    Article  PubMed  Google Scholar 

  22. Gurtner GC et al (2013) Intraoperative laser angiography using the SPY system: review of the literature and recommendations for use. Ann Surg Innov Res 7(1):1

    Article  PubMed  PubMed Central  Google Scholar 

  23. Phillips BT et al (2012) Intraoperative perfusion techniques can accurately predict mastectomy skin flap necrosis in breast reconstruction: results of a prospective trial. Plast Reconstr Surg 129(5):778e–788e

    Article  PubMed  Google Scholar 

  24. Moyer HR, Losken A (2012) Predicting mastectomy skin flap necrosis with indocyanine green angiography: the gray area defined. Plast Reconstr Surg 129(5):1043–1048

    Article  CAS  PubMed  Google Scholar 

  25. Newman MI et al (2011) An investigation of the application of laser-assisted indocyanine green fluorescent dye angiography in pedicle transverse rectus abdominus myocutaneous breast reconstruction. Can J Plast Surg 19(1):e1–e5

    PubMed  PubMed Central  Google Scholar 

  26. Komorowska-Timek E, Gurtner GC (2010) Intraoperative perfusion mapping with laser-assisted indocyanine green imaging can predict and prevent complications in immediate breast reconstruction. Plast Reconstr Surg 125(4):1065–1073

    Article  CAS  PubMed  Google Scholar 

  27. Pestana IA et al (2009) Early experience with fluorescent angiography in free-tissue transfer reconstruction. Plast Reconstr Surg 123(4):1239–1244

    Article  CAS  PubMed  Google Scholar 

  28. Azuma R et al (2008) Detection of skin perforators by indocyanine green fluorescence nearly infrared angiography. Plast Reconstr Surg 122(4):1062–1067

    Article  CAS  PubMed  Google Scholar 

  29. Giunta RE et al (2005) Prediction of flap necrosis with laser induced indocyanine green fluorescence in a rat model. Br J Plast Surg 58(5):695–701

    Article  CAS  PubMed  Google Scholar 

  30. Wang HD, Singh DP (2012) The use of indocyanine green angiography to prevent wound complications in ventral hernia repair with open components separation technique. Hernia 17(3):397–402

    Article  PubMed  Google Scholar 

  31. Benya R, Quintana J, Brundage B (1989) Adverse reactions to indocyanine green: a case report and a review of the literature. Cathet Cardiovasc Diagn 17(4):231–233

    Article  CAS  PubMed  Google Scholar 

  32. Ishihara H et al (1998) Detection of capillary protein leakage by glucose and indocyanine green dilutions during the early post-burn period. Burns 24(6):525–531

    Article  CAS  PubMed  Google Scholar 

  33. Lifecell corp (2012) SPY Elite intraoperative perfusion assessment system: SPY Elite Pack and SPY Elite Kit Instructions for Use. Branchburg, Lifecell corp

    Google Scholar 

  34. Iseki K et al (1980) Shock caused by indocyanine green dye in chronic hemodialysis patients. Clin Nephrol 14(4):210

    CAS  PubMed  Google Scholar 

  35. Hope-Ross M et al (1994) Adverse reactions due to indocyanine green. Ophthalmology 101(3):529–533

    Article  CAS  PubMed  Google Scholar 

  36. Newman MI, Samson MC (2009) The application of laser-assisted indocyanine green fluorescent dye angiography in microsurgical breast reconstruction. J Reconstr Microsurg 25(1):21–26

    Article  PubMed  Google Scholar 

  37. Keats AS (1978) The ASA classification of physical status–a recapitulation. Anesthesiology 49(4):233–236

    Article  CAS  PubMed  Google Scholar 

  38. Harris PA et al (2009) Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42(2):377–381

    Article  PubMed  Google Scholar 

  39. Jones RS, Brown C, Opelka F (2005) Surgeon compensation: “Pay for performance,” the American College of Surgeons National Surgical Quality Improvement Program, the Surgical Care Improvement Program, and other considerations. Surgery 138(5):829–836

    Article  PubMed  Google Scholar 

  40. Novitsky YW et al (2006) Open preperitoneal retrofascial mesh repair for multiply recurrent ventral incisional hernias. J Am Coll Surg 203(3):283–289

    Article  PubMed  Google Scholar 

  41. Patel KM et al (2013) Use of intraoperative indocyanin-green angiography to minimize wound healing complications in abdominal wall reconstruction. J Plast Surg Hand Surg 47(6):476–480

    PubMed  Google Scholar 

  42. American Burn Association (1990) Hospital and prehospital resources for optimal care of patients with burn injury: guidelines for development and operation of burn centers. J Burn Care Rehabil 11(2):98–104

    Google Scholar 

  43. Mothes H et al (2004) Indocyanine-green fluorescence video angiography used clinically to evaluate tissue perfusion in microsurgery. J Trauma 57(5):1018–1024

    Article  PubMed  Google Scholar 

  44. McEvoy GK (ed) (1988) Cardiac function. Indocyanine green. Drug info 88: American Hospital Formulary Service. American Society of Hospital Pharmacists, Bethesda, pp 1190–1191

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Gastrointestinal and Minimally Invasive Surgery, Department of General Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC, 28204, USA

    P. D. Colavita, B. A. Wormer, I. Belyansky, A. Lincourt, S. B. Getz, B. T. Heniford & V. A. Augenstein

Authors
  1. P. D. Colavita
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. B. A. Wormer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. I. Belyansky
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Lincourt
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S. B. Getz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. B. T. Heniford
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. V. A. Augenstein
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to V. A. Augenstein.

Ethics declarations

Conflict of interest

The study was conducted with a grant from LifeCell for materials only. PC declares no other conflicts of interest. BW declares no other conflicts of interest. IB declares no pertinent conflicts of interest, but is a speaker for W. L. Gore and Lifecell. AL declares no other conflicts of interest. SG declares no other conflicts of interest. BH has received grants from LifeCell and W. L. Gore. BH has received personal fees from W. L. Gore, LifeCell, Ethicon, and Davol. VA is a consultant for LifeCell.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Colavita, P.D., Wormer, B.A., Belyansky, I. et al. Intraoperative indocyanine green fluorescence angiography to predict wound complications in complex ventral hernia repair. Hernia 20, 139–149 (2016). https://doi.org/10.1007/s10029-015-1411-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10029-015-1411-4

Keywords

Search

Navigation