Intraoperative indocyanine green fluorescence angiography for the assessment of flap perfusion in head and neck oncological reconstruction: a systematic review.

Authors

Jai Parkash Ramchandani, Oliver Vij, Sanjeev Chaand Sharma, Alexander Goodson

Published in

The British journal of oral & maxillofacial surgery. Sep 01, 2026. Epub Sep 01, 2026.

Abstract

The aim of the current study was to evaluate the clinical utility of intraoperative indocyanine green fluorescence angiography (ICG-FA) for the assessment of perfusion in head and neck oncological flap reconstruction and its association with outcomes and intraoperative decision-making. In a PRISMA-compliant systematic review, MEDLINE, Embase, and CENTRAL databases were searched from inception to 19 February 2026. Eligible studies included adults undergoing head and neck oncological resection with free or pedicled flap reconstruction using intraoperative ICG-FA. Primary outcomes were return to theatre, partial flap necrosis, total flap loss, and flap salvage. Secondary outcomes included fistula, wound dehiscence, infection, and the impact of intraoperative decisions. Two reviewers independently performed the study selection, data extraction, and risk of bias assessment. Owing to heterogeneity, the findings were synthesised narratively. Ten observational studies were included, comprising 468 ICG-assessed flaps in 463 patients; two comparative studies also contributed 316 non-ICG comparator flaps. Most reconstructions were free flaps (90.6%). Re-exploration occurred in 12.4% (56/450) of ICG-assessed flaps, partial flap necrosis in 4.8% (4/83), and total flap loss in 3.5% (15/423). Salvage was achieved in 73.3% (33/45) of compromised flaps. Intraoperative management changed in 12.8% (12/94) of flaps. Risk of bias was significant in both comparative studies and moderate across the non-comparative series. ICG-FA appears to be a useful adjunct to the assessment of intraoperative perfusion, with the clearest potential benefit in flap salvage, flap loss, and operative decision-making. However, the evidence base was limited by the observational study design, heterogeneity, and risk of bias. Prospective comparative studies using standardised protocols are needed before routine adoption can be recommended.

PMID:
42888156
Bibliographic data and abstract were imported from PubMed on 17 Oct 2026.

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