{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:45:11Z","timestamp":1792025111297,"version":"4.4.0"},"reference-count":49,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2023,5,11]],"date-time":"2023-05-11T00:00:00Z","timestamp":1683763200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Indocyanine green angiography (ICG\u2010A) has been widely applied for intraoperative flap assessment in DIEP flap breast reconstruction. However, the beneficial effect of ICG\u2010A in DIEP flap breast reconstruction is still uncertain and no standardized protocol is available. This study aims to analyze the clinical outcome and comprehensively review protocols of this field.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A systematic review was conducted in MEDLINE, EMBASE, and Cochrane CENTRAL databases until September 15, 2022. Studies on the utility of intraoperative ICG\u2010A in DIEP breast reconstruction were included. Data reporting reconstruction outcomes were extracted for pooled analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 22 studies were enrolled in the review, among five studies with 1021 patients included in the meta\u2010analysis. The protocols of ICG\u2010A assessment of DIEP flap varied among studies. According to the pooled results, the incidence of postoperative fat necrosis was 10.89% (50 of 459 patients) with ICG\u2010A and 21.53% (121 of 562 patients) with clinical judgment. The risk for postoperative fat necrosis was significantly lower in patients with intraoperative ICG\u2010A than without (RR 0.47 95% CI 0.29\u20130.78, <jats:italic>p<\/jats:italic>\u2009=\u2009.004, <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u200951%). Reoperation occurred in 5 of 48 patients (10.42%) in the ICG\u2010A group and in 21 of 64 patients (32.82%) in the control group summarized from reports in two studies. The risk for reoperation was lower in the ICG\u2010A group than in the control group (RR 0.41 95% CI 0.18\u20130.93, <jats:italic>p<\/jats:italic>\u2009=\u2009.03, <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u20090%). Other complications, including flap loss, seroma, hematoma, dehiscence, mastectomy skin necrosis, and infection, were comparable between the two groups. Heterogeneities among studies were acceptable. No significant influence of specific studies was identified in sensitivity analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>ICG\u2010A is an accurate and reliable way to identify problematic perfusion of DIEP flaps during breast reconstruction. Protocols of ICG\u2010A differed in current studies. Intraoperative ICG\u2010A significantly decreases the rate of fat necrosis and reoperation in patients undergoing DIEP breast reconstruction. The synthesized results should be interpreted sensibly due to the sample size limitation. RCTs on the outcomes and high\u2010quality studies for an optimized ICG\u2010A protocol are still needed in the future.<\/jats:p><\/jats:sec>","DOI":"10.1002\/micr.31056","type":"journal-article","created":{"date-parts":[[2023,5,11]],"date-time":"2023-05-11T08:38:51Z","timestamp":1683794331000},"page":"627-638","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":35,"title":["Flap perfusion assessment with indocyanine green angiography in deep inferior epigastric perforator flap breast reconstruction: A systematic review and meta\u2010analysis"],"prefix":"10.1002","volume":"43","author":[{"given":"Zhaojian","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital Chinese Academy of Medical Sciences &amp; Peking Union Medical College  Beijing People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling","family":"Jiao","sequence":"additional","affiliation":[{"name":"Department of Dermatology, West China Hospital Sichuan University  Chengdu People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siliang","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Dermatology, West China Hospital Sichuan University  Chengdu People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhijin","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital Chinese Academy of Medical Sciences &amp; Peking Union Medical College  Beijing People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiding","family":"Xiao","sequence":"additional","affiliation":[{"name":"Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital Chinese Academy of Medical Sciences &amp; Peking Union Medical College  Beijing People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fengzhou","family":"Du","sequence":"additional","affiliation":[{"name":"Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital Chinese Academy of Medical Sciences &amp; Peking Union Medical College  Beijing People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiuzuo","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital Chinese Academy of Medical Sciences &amp; Peking Union Medical College  Beijing People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao","family":"Long","sequence":"additional","affiliation":[{"name":"Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital Chinese Academy of Medical Sciences &amp; Peking Union Medical College  Beijing People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,5,11]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1155\/2012\/940585"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000637-199401000-00007"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2020.01.019"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2018.1687"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0040-1710552"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2017.01.020"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e318219c171"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e31828659f4"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000003560"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0042-1742303"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0039-6257(00)00123-5"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1177\/1090820X13514995"},{"key":"e_1_2_10_14_1","first-page":"248","article-title":"A clinical technique and apparatus for simultaneous angiography of the separate retinal and choroidal circulations","volume":"12","author":"Flower R. 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