Imaging for Reconstructive Microsurgery: Indocyanine Green

The role of indocyanine green (ICG) in reconstructive microsurgery continues to evolve. In patients with lymphedema, ICG lymphography is instrumental in identifying normal and pathological lymphatic channels, assessing the suitability and optimal location for lymphovenous bypass and staging lymphedema severity. The use of ICG and radioactive tracers in reverse lymphatic mapping also offers technical refinements for vascularized lymph node transplant procedures to minimize donor site morbidity. Moreover, ICG angiography for free flaps is an excellent intraoperative tool to assess perforosomal perfusion and to potentially mitigate skin and fat necroses. As is the case with all emerging imaging technology, further standardization of ICG technical use and the assessment of results is required. This will only help improve the efficiency and its scope of use in the future.