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Table 2 Clinical evidence of utility the SPY system, by application

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

Authors Study design Applications studied Key points
Free flaps
Pestana et al., 2009 [5] Case series Multiple indications: head and neck, breast, lower extremity 1 partial flap loss
N = 27 patients, 29 free tissue transfers
Breast recon-struction
Phillips et al., 2012 [12] Prospective study comparing ICG to fluorescein and clinical judgment Tissue expander-implant breast reconstruction ICG and fluorescein had sensitivity of 90% and specificity of 50% and 30%, respectively; negative predictive value for ICG and fluorescein was 88% and 82%, respectively.
N = 32 patients, 51 breasts
Newman et al., 2011 [6] Case series Breast reconstruction: single-pedicle TRAM ICG perfusion assessment identified perfusion zones; no issues with wound healing or tissue or fat necrosis.
N = 20
Komorowska-Timek and Gurtner, 2010 [1] Case series Breast reconstruction: tissue expander, latissimus dorsi flaps, DIEP/SIEA Tissue expander (n = 16), latissimus dorsi (n = 2), DIEP/SIEA (n = 6); complication rate: 4% with ICG vs. 15.1% in 206 previous reconstructions (n = 148; p < 0.01)
N = 20 patients, 24 breasts
Tamburrino et al., 2010 [17] Retrospective analysis Breast reconstruction: tissue expander or unilateral TRAM 95% correlation between ICG imaging and clinical outcome, 100% sensitivity and 91% specificity.
Tissue expander (n = 11 patients, 19 breasts)
Unilateral TRAM (n = 1)
Francisco et al., 2010 [52] Case series N = 5 Breast reconstruction: DIEP No flap loss, fat necrosis, or take-backs
Jones et al., 2009 [14] Case series Breast reconstruction: free and pedicle TRAM, DIEP, latissimus dorsi, and expander insertions. Of 5 patients with poor flap perfusion on ICG imaging, 4 developed necrosis and 1 blistering in a pattern predicted by ICG; necrosis rate of 6.3% vs. published rates of 15-25%.
N = 43 patients, 64 breasts
Newman & Samson, 2009 [11] Case series Breast reconstruction: DIEP or free TRAM ICG detected marginal or poor perfusion in 4 cases; 3 were revised intraoperatively and the 1 that was not revised required return to OR for venous congestion. Flap survival was 100%.
N = 8 patients, 10 breasts
NAC evaluation
Murray et al., 2010 [16] Case series Breast reduction surgery ICG used to demonstrate NAC perfusion and venous outflow during surgery.
  N = 12 patients, 22 breasts   
  1. DIEP: deep inferior epigastric perforator.
  2. NAC: nipple-areolar complex.
  3. SIEA: superficial inferior epigastric artery flap.
  4. TRAM: transverse abdominus musculocutaneous.