The Role of Indocyanine Green Fluorescence Angiography in Complex Abdominal Wall Reconstruction: A Scoping Review of the Literature

Abstract Background Indocyanine green fluorescence angiography (ICGFA) is a technique for assessing vascularity and perfusion which has multiple proven applications across a variety of surgical procedures. Studies have been performed assessing its potential role in evaluating skin flap viability in complex abdominal wall reconstruction (CAWR) in order to avoid postoperative surgical site occurrences (SSO). Objectives This review is intended to summarise the literature concerning ICGFA in CAWR in order to facilitate future evidence based guidelines for its use. Eligibility Criteria Inclusion - Cohort studies, randomized controlled trials, case series, case reports, ventral midline hernias only. Exclusion - patients aged under 18 years, non-human test subjects. Sources of Evidence PubMed, MEDLINE®, Cochrane, Embase, OpenGrey Results 3,416 unique titles were yielded from our search of which 9 met our inclusion criteria - 3 case reports, 1 retrospective case series, 1 prospective case series, 3 non-blinded, non-randomized retrospective case-controlled studies and 1 prospective, double-blinded randomized controlled study. The included studies varied considerably in size and method however the consensus appeared to support ICGFA as being a safe and feasible means of assessing tissue flap vascularity in CAWR. The studies returned contrasting results regarding the impact of ICGFA in predicting and avoiding SSOs however there were insufficient numbers of studies for a meta-analysis. Conclusions We identify 3 case reports and 4 lower quality studies suggesting a possible application for ICGFA in CAWR and 2 higher quality studies showing no overall benefit. Evidence based guidelines on the role of ICGFA in CAWR will require the assessment of further studies.