Ricerc@Sapienza

Since its introduction, the indocyanine green (ICG) has been used in various medical specialties. In injected interstitially, it can allow visualizing in real-time subcutaneous lymphatic flow. ICG lymphangiography may result a useful tool for surgeons dealing with lymphedema. Thanks to its proven safety, low costs, low invasiveness and suitability for lymphatic channel assessment, ICG lymphangiography may be used to assess lymphedema severity and enable surgeons to preoperatively stage and select patients who are most suitable for lymphovenous bypass.
ICG lymphangiography has already been tested in sentinel lymph node biopsy (SLNB) in breast cancer treatment. Despite encouraging preliminary results that showed potential advantages over traditional methods, to date there is no consensus on how ICG could complement or replace other validated methods of SLN mapping.
ICG technology has shown more potential in breast cancer surgery. ICG angiography can locate the poorly perfused areas of mastectomy flaps intra-operatively and so help the surgeon to remove them and avoid necrosis complication. Also, in autologous breast reconstruction, the flap perfusion can be assessed using ICG angiography. This check on tissue reliability allows an intraoperative immediate revision, thereby avoiding the patient potential post-operative take-back to surgery for revision. Despite these potential advantages have already been published, there is still no consensus nor validated protocol for ICG angiography use in breast surgery.
The aim of our study is to investigate if the ICG lymphangiography method can be considered equivalent or superior to standard lymphoscintigraphy in lymphedema surgery and in sentinel node detection with traditional radioisotope. Moreover, we would evaluate the role of ICG angiography in assessing mastectomy skin flaps perfusion and flap perfusion in autologous breast reconstruction surgeries.