Table 3 Overall recommendations regarding use of the SPY System in reconstructive procedures, by flap type

Free flaps

1. Identify perforator perfusion zone in donor site prior to incision; select optimal perforator and design flap

2. Confirm flap perfusion during dissection, testing and comparing different perforators

3. Confirm flap perfusion after transfer

4. Confirm patency of arterial and venous anastomoses

5. Detect areas of venous congestion by re-imaging 5–20 min after administration of ICG; can be performed following flap dissection, transfer, and/or inset

Pedicle flap

1. Identify perforator perfusion zone in donor site prior to incision; design flap

2. Evaluate arterial and venous perfusion after elevation of flap and prior to transfer

3. After transfer and after inset, confirm arterial inflow and venous return

Skin flap

1. Evaluate perfusion prior to incision; design flap

2. After dissection, confirm flap perfusion

3. After transfer and inset, confirm perfusion of flap

Mastectomy flap

1. Following mastectomy, confirm integrity of vascular perfusion in mastectomy flaps; select delayed vs. immediate reconstruction; select implant vs. expander reconstruction

2. Confirm perfusion after insertion of reconstructive modality; determine expander volume or implant size; determine skin paddle size

3. If revisions made, confirm perfusion in flaps