The impact of indocyanine green fluorescence imaging on skin flap necrosis: a systematic review and meta-analysis
Abstract Background Skin flap necrosis is a prevalent complication following mastectomy, significantly impacting patient recovery. Indocyanine green (ICG) fluorescence imaging offers intraoperative guidance by providing real-time evaluation of tissue perfusion; however, its efficacy in reducing post...
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2025-07-01
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| Online Access: | https://doi.org/10.1186/s12893-025-03048-8 |
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| author | Lin Chun Zhiping Fu YingJun Zheng Haomin Lin Yue Hu Donglun Li |
| author_facet | Lin Chun Zhiping Fu YingJun Zheng Haomin Lin Yue Hu Donglun Li |
| author_sort | Lin Chun |
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| description | Abstract Background Skin flap necrosis is a prevalent complication following mastectomy, significantly impacting patient recovery. Indocyanine green (ICG) fluorescence imaging offers intraoperative guidance by providing real-time evaluation of tissue perfusion; however, its efficacy in reducing postoperative necrosis remains a subject of debate. This study seeks to elucidate the impact of ICG on postoperative skin flap necrosis and the rate of reoperation through a systematic review and meta-analysis. Methods We systematically searched the PubMed, Embase, and Cochrane Library databases, incorporating seven retrospective cohort studies and one prospective study into our analysis. Data analysis was performed using Review Manager 5.4, this systematic review and meta-analysis was reported in accordance with the PRISMA guidelines. Results Our analysis included eight articles with a total of 1,252 patients who underwent mastectomy and breast flap reconstructive surgery. Our findings indicate that, compared with the control treatment, the use of indocyanine green (ICG) can significantly reduce the occurrence of skin flap necrosis (OR = 0.60; 95% CI 0.44 to 0.81; I 2 = 0%; P = 0.001), severe flap necrosis (OR = 0.37; 95% CI 0.22 to 0.63; I 2 = 0%; P = 0.0002), and reoperation (OR = 0.49; 95% CI 0.33 to 0.73; I 2 = 28%; P = 0.0005). Conclusions The findings suggest that ICG can effectively reduce the risk of severe skin flap necrosis and the necessity for reoperation post-mastectomy, although its benefits for mild to moderate necrosis are limited. Future research should focus on multicenter randomized controlled trials to standardize the application of ICG and assess its feasibility in resource-constrained settings. |
| format | Article |
| id | doaj-art-190f7a2a978d40aabe66fca8585c77f0 |
| institution | Kabale University |
| issn | 1471-2482 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
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| series | BMC Surgery |
| spelling | doaj-art-190f7a2a978d40aabe66fca8585c77f02025-08-20T03:45:40ZengBMCBMC Surgery1471-24822025-07-0125111210.1186/s12893-025-03048-8The impact of indocyanine green fluorescence imaging on skin flap necrosis: a systematic review and meta-analysisLin Chun0Zhiping Fu1YingJun Zheng2Haomin Lin3Yue Hu4Donglun Li5Department of Thyroid and Breast Surgery, Guangyuan Central HospitalDepartment of Thyroid and Breast Surgery, Guangyuan Central HospitalDepartment of Hepatobiliary Surgery of the First People’s Hospital of Dazhou City（Sichuan Provincial People’s Hospital Chuandong Hospital)Department of Hepatobiliary Pancreatic Surgery, Chengdu Sixth People’s HospitalDepartment of Rehabilitation, The Affiliated Hospital of Southwest Medical UniversityDepartment of Nephrology, University Hospital Essen, University of Duisburg-EssenAbstract Background Skin flap necrosis is a prevalent complication following mastectomy, significantly impacting patient recovery. Indocyanine green (ICG) fluorescence imaging offers intraoperative guidance by providing real-time evaluation of tissue perfusion; however, its efficacy in reducing postoperative necrosis remains a subject of debate. This study seeks to elucidate the impact of ICG on postoperative skin flap necrosis and the rate of reoperation through a systematic review and meta-analysis. Methods We systematically searched the PubMed, Embase, and Cochrane Library databases, incorporating seven retrospective cohort studies and one prospective study into our analysis. Data analysis was performed using Review Manager 5.4, this systematic review and meta-analysis was reported in accordance with the PRISMA guidelines. Results Our analysis included eight articles with a total of 1,252 patients who underwent mastectomy and breast flap reconstructive surgery. Our findings indicate that, compared with the control treatment, the use of indocyanine green (ICG) can significantly reduce the occurrence of skin flap necrosis (OR = 0.60; 95% CI 0.44 to 0.81; I 2 = 0%; P = 0.001), severe flap necrosis (OR = 0.37; 95% CI 0.22 to 0.63; I 2 = 0%; P = 0.0002), and reoperation (OR = 0.49; 95% CI 0.33 to 0.73; I 2 = 28%; P = 0.0005). Conclusions The findings suggest that ICG can effectively reduce the risk of severe skin flap necrosis and the necessity for reoperation post-mastectomy, although its benefits for mild to moderate necrosis are limited. Future research should focus on multicenter randomized controlled trials to standardize the application of ICG and assess its feasibility in resource-constrained settings.https://doi.org/10.1186/s12893-025-03048-8Indocyanine greenMastectomyFlap necrosisBreast reconstructionReoperation |
| spellingShingle | Lin Chun Zhiping Fu YingJun Zheng Haomin Lin Yue Hu Donglun Li The impact of indocyanine green fluorescence imaging on skin flap necrosis: a systematic review and meta-analysis BMC Surgery Indocyanine green Mastectomy Flap necrosis Breast reconstruction Reoperation |
| title | The impact of indocyanine green fluorescence imaging on skin flap necrosis: a systematic review and meta-analysis |
| title_full | The impact of indocyanine green fluorescence imaging on skin flap necrosis: a systematic review and meta-analysis |
| title_fullStr | The impact of indocyanine green fluorescence imaging on skin flap necrosis: a systematic review and meta-analysis |
| title_full_unstemmed | The impact of indocyanine green fluorescence imaging on skin flap necrosis: a systematic review and meta-analysis |
| title_short | The impact of indocyanine green fluorescence imaging on skin flap necrosis: a systematic review and meta-analysis |
| title_sort | impact of indocyanine green fluorescence imaging on skin flap necrosis a systematic review and meta analysis |
| topic | Indocyanine green Mastectomy Flap necrosis Breast reconstruction Reoperation |
| url | https://doi.org/10.1186/s12893-025-03048-8 |
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