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Intraoperative laser angiography using the SPY system: review of the literature and recommendations for use

Geoffrey C Gurtner1, Glyn E Jones2, Peter C Neligan3, Martin I Newman4, Brett T Phillips5, Justin M Sacks6 and Michael R Zenn7*

Author Affiliations

1 Stanford Hospital and Clinics, Palo Alto, CA, USA

2 Peoria Surgical Group, Peoria, IL, USA

3 University of Washington Medical Center, Seattle, WA, USA

4 Cleveland Clinic Florida, Westin, FL, USA

5 Stony Brook Medical Center, Stony Brook, NY, USA

6 Johns Hopkins School of Medicine, Baltimore, MD, USA

7 Plastic and Reconstructive Surgery, Duke University Medical Center, Durham, NC, USA

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Annals of Surgical Innovation and Research 2013, 7:1  doi:10.1186/1750-1164-7-1

Published: 7 January 2013


Inadequate tissue perfusion is a key contributor to early complications following reconstructive procedures. Accurate and reliable intraoperative evaluation of tissue perfusion is critical to reduce complications and improve clinical outcomes. Clinical judgment is the most commonly used method for evaluating blood supply, but when used alone, is not always completely reliable. A variety of other methodologies have been evaluated, including Doppler devices, tissue oximetry, and fluorescein, among others. However, none have achieved widespread acceptance. Recently, intraoperative laser angiography using indocyanine green was introduced to reconstructive surgery. This vascular imaging technology provides real-time assessment of tissue perfusion that correlates with clinical outcomes and can be used to guide surgical decision making. Although this technology has been used for decades in other areas, surgeons may not be aware of its utility for perfusion assessment in reconstructive surgery. A group of experts with extensive experience with intraoperative laser angiography convened to identify key issues in perfusion assessment, review available methodologies, and produce initial recommendations for the use of this technology in reconstructive procedures.

SPY; Indocyanine green; Laser angiography; Reconstructive surgery; Perfusion assessment; Flap; Near infrared; Necrosis; Flap; Microsurgery