Available and emerging technologies for assessing intraoperative tissue perfusion during complex ventral hernia repair procedures

Stephen J Ferzoco Dedham Medical Associates, Dedham, MA, USA Abstract: Abdominal wall reconstructions, and complex ventral hernia repairs in particular, pose significant challenges to surgeons and are associated with serious postoperative wound healing complications often related to poor tissue perfusion. Maintenance of adequate perfusion of central adipocutaneous tissue is critical for minimizing risk of wound-related complications following herniorrhaphy; however, accurate tissue perfusion assessment can be challenging in this setting. Technologies such as thermography and laser Doppler flowmetry are not widely used in clinical settings to assess tissue perfusion, and most surgeons currently rely upon subjective assessments of tissue viability to guide intraoperative decisions regarding reconstruction. New technological developments, including spectroscopic imaging and indocyanine green-based near-infrared laser fluorescence, permit quantitative, real-time, intraoperative visualization of tissue perfusion and have demonstrated sensitivity and accuracy in a variety of reconstructive settings. Evidence suggests these technologies can be used to optimize perfusion at the time of operation and prevent perfusion-related complications such as flap necrosis. Future studies and physician reports describing these perfusion assessment technologies in complex ventral hernia repair will supply important information regarding their utility in patients undergoing this procedure. Keywords: indocyanine green imaging, spectroscopic imaging, hernia repair, intraoperative tissue perfusion, complications, tissue ischemi