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Table 4 Technical recommendations for use of the SPY System

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

Application

Timing of evaluation*

Microvascular reconstructive surgery

Pre-incision identification of perforators

15-30 sec

Following dissection, confirmation of adequate flow and limits of perfusion

1-2 min

Following transfer, evaluation of arterial and venous anastomoses

Arterial phase: instantaneous.

Venous phase: 30–60 sec

Re-image at 2 min; if venous congestion is suspected, evaluate again at ≥4 min

Following inset, confirmation of adequate flow and limits of perfusion

1-2 min (Wait at least 10 min following previous ICG administration)

Pedicle flap reconstruction

Pre-incision identification of perforator perfusion zone

≤1 min

Following elevation of flap, confirmation of adequate flow and limits of perfusion (selection of skin and soft tissue for preservation)

1-2 min

Following transposition and inset, confirmation of adequate flow and limits of perfusion

1-2 min

Skin flap reconstruction**

Following elevation of skin flap, define limits of perfusion for flap design and detect sub-clinical ischemia

1-2 min

Following transposition and inset to confirm adequate perfusion

1-2 min (Wait at least 10 min following previous ICG administration)

Mastectomy followed by TE/I reconstruction

Pre-mastectomy, map the vessels and the perfusion surrounding the nipple-areolar complex

15-30 sec

Following mastectomy, assess perfusion along the skin/tissue edges of the flap† Wait 30–45 minutes following completion of mastectomy procedure to ensure recovery of perfusion. If no fluorescence is detected after this time period, additional wait time of up to 30 minutes may be appropriate.

3-4 min

With implant or tissue expander in place, evaluate mastectomy skin flap prior to filling expander

Wait 5 min after insertion of implant or tissue expander before imaging

After filling tissue expander, evaluate skin flaps, nipple-areolar complex, and surrounding tissue perfusion

Wait 5 min after filling tissue expander before imaging

  1. TE/I = tissue expander/implant.
  2. * Start recording after first appearance of fluorescent blush. Times given indicate when within the captured image sequence assessments should be made.
  3. **For areas or conditions associated with reduced perfusion (eg, lower extremities, vasculopathy), longer wait times may be required before evaluation.
  4. Notes: The Instructions for Use supplied with SPY note that the 25 mg ICG should be reconstituted in 10 cc of normal saline, giving a concentration of 2.5 mg/cc [15]. The Instructions for Use suggest administration of 10 mg (or 4 cc) ICG for visualization of tissue perfusion. For restudy, wait ≥10 min from previous injection of ICG. Take a baseline image before restudy to ensure that ICG has washed out. If complete wash out is needed, wait 15 minutes from previous ICG administration.
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Annals of Surgical Innovation and Research

ISSN: 1750-1164

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