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      Case Report: Indocyanine Green-Based Angiography for Real-Time Assessment of Superficial Brachialis Axial Pattern Flap Vascularization in Two Dogs

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          Abstract

          This case report describes the method and feasibility of near-infrared angiography (NIRA) to improve the surgical procedure of two superficial brachial axial pattern flaps intraoperatively using two camera systems. Two client-owned dogs were treated for tumors on their antebrachia with wide surgical excision. The defects were closed with a superficial brachial flap in both cases. A different NIRA camera system was used for each case to identify the perforator vessel and flap margins accordingly. Case 1 developed a seroma and healed without further complications. Case 2 developed partial flap necrosis, underwent revision surgery, and healed by secondary intent. NIRA proved useful intraoperatively in identifying the perforator vessel and determining flap margins. As these are only two cases, caution should be used in extrapolating the results.

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          Most cited references25

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          A Review of Indocyanine Green Fluorescent Imaging in Surgery

          The purpose of this paper is to give an overview of the recent surgical intraoperational applications of indocyanine green fluorescence imaging methods, the basics of the technology, and instrumentation used. Well over 200 papers describing this technique in clinical setting are reviewed. In addition to the surgical applications, other recent medical applications of ICG are briefly examined.
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            Review of fluorescence guided surgery systems: identification of key performance capabilities beyond indocyanine green imaging.

            There is growing interest in using fluorescence imaging instruments to guide surgery, and the leading options for open-field imaging are reviewed here. While the clinical fluorescence-guided surgery (FGS) field has been focused predominantly on indocyanine green (ICG) imaging, there is accelerated development of more specific molecular tracers. These agents should help advance new indications for which FGS presents a paradigm shift in how molecular information is provided for resection decisions. There has been a steady growth in commercially marketed FGS systems, each with their own differentiated performance characteristics and specifications. A set of desirable criteria is presented to guide the evaluation of instruments, including: (i) real-time overlay of white-light and fluorescence images, (ii) operation within ambient room lighting, (iii) nanomolar-level sensitivity, (iv) quantitative capabilities, (v) simultaneous multiple fluorophore imaging, and (vi) ergonomic utility for open surgery. In this review, United States Food and Drug Administration 510(k) cleared commercial systems and some leading premarket FGS research systems were evaluated to illustrate the continual increase in this performance feature base. Generally, the systems designed for ICG-only imaging have sufficient sensitivity to ICG, but a fraction of the other desired features listed above, with both lower sensitivity and dynamic range. In comparison, the emerging research systems targeted for use with molecular agents have unique capabilities that will be essential for successful clinical imaging studies with low-concentration agents or where superior rejection of ambient light is needed. There is no perfect imaging system, but the feature differences among them are important differentiators in their utility, as outlined in the data and tables here.
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              Indocyanine green applications in plastic surgery: A review of the literature.

              Use of indocyanine green (ICG) near-infrared fluorescence as a dye to assess tissue vascularization is now well standardized. The aim of this literature review was to review and resume the most recent recommendations for ICG use in its plastic surgery applications.
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                Author and article information

                Contributors
                Journal
                Front Vet Sci
                Front Vet Sci
                Front. Vet. Sci.
                Frontiers in Veterinary Science
                Frontiers Media S.A.
                2297-1769
                18 April 2022
                2022
                : 9
                : 859875
                Affiliations
                Clinic for Small Animal Surgery, Vetsuisse Faculty, University of Zurich , Zurich, Switzerland
                Author notes

                Edited by: Christopher Bruce Riley, Massey University, New Zealand

                Reviewed by: Hiroo Suami, Macquarie University, Australia; Radu Olariu, Bern University Hospital, Switzerland

                *Correspondence: David Michalik david.michalik@ 123456gmx.de

                This article was submitted to Veterinary Surgery and Anesthesiology, a section of the journal Frontiers in Veterinary Science

                Article
                10.3389/fvets.2022.859875
                9059970
                35510213
                96508405-0fe9-48dd-a0d8-a551a75b7aa4
                Copyright © 2022 Michalik and Nolff.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 21 January 2022
                : 09 March 2022
                Page count
                Figures: 4, Tables: 0, Equations: 0, References: 25, Pages: 7, Words: 4516
                Categories
                Veterinary Science
                Case Report

                near infrared angiography,nira,indocyanine green,icg,axial pattern flaps,superficial brachial,skin reconstruction

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