🔍 Key Findings
- Caudal superficial epigastric (CSE) flaps were most visible with NIRFA, scoring 4/4 VFP in 97% of evaluations.
- CSE flap margins were altered in 65% of observations after NIRFA, showing the strongest influence on surgical planning.
- Thoracodorsal (THO) and omocervical (OMO) flaps had lower visualization scores, with 60–81% of images scoring below 2.
- Surgeons were 17–25 times more likely to adjust margins for CSE flaps versus OMO or THO based on fluorescence imaging.
- Poor inter-rater agreement was found for OMO (ICC 0.49) and THO (ICC 0.35); CSE had near-perfect agreement, but ICC was low due to uniform high scoring.
- Visualization was affected by flap depth and panniculus, making deeper vessels (OMO, THO) harder to see.
- Surgeons often shortened flap length and reduced flap area when modifying based on NIRFA results.
- Real-time angiosome visualization via NIRFA-ICG may reduce necrosis risk and improve patient-specific APF design.
