ICG Fluorescence for Burn Depth Assessment: Systematic Review Findings

An ICG fluorescence imaging systematic review describes indocyanine green (ICG) fluorescence imaging as an adjunct studied for burn depth assessment. In the summary, two studies reported high accuracy for identifying nonviable tissue, while differentiation between superficial and deep partial-thickness burns was inconsistent; the authors also note a potential intraoperative role during necrosectomy.

The systematic review included nine studies totaling 151 patients, spanning publications from 1995 through 2024. Results were synthesized descriptively rather than pooled quantitatively, citing substantial methodological heterogeneity as the reason. The study also notes heterogeneity in measurement protocols, cut-off values, and reference standards that limited comparability across studies. This between-study variation largely determined the level of synthesis that could be presented.

Within that descriptive synthesis, the study highlights that two included studies reported high accuracy of ICG fluorescence imaging for identifying nonviable tissue and supporting surgical planning. It contrasts this with inconsistent performance when studies attempted to differentiate superficial partial-thickness from deep partial-thickness burns. Rather than presenting a uniformly reliable depth-classification tool, the study positions ICG as showing a clearer signal for nonviable tissue identification than for resolving partial-thickness depth categories.

The study also places ICG findings alongside clinical assessment and other reference methods, including histology/biopsy and modalities such as Laser Doppler imaging. Heterogeneity is attributed to differences in measurement protocols, selected cut-off values, and the reference standards used to judge burn depth. Included studies compared ICG with at least one reference method, such as clinical assessment, biopsy/histology, or other technical modalities. As summarized there, these design variations limited comparability across the included studies.

One included study is singled out for a potential decision-impact observation: ICG-guided assessment reportedly reduced or avoided excision in 10 of 20 burn sites. In its conclusion, the study states that ICG imaging has restricted utility for burn depth assessment because of limited accuracy in differentiating superficial versus deep partial-thickness burns, while still suggesting potential intraoperative benefit during necrosectomy. Overall, the bottom line is that depth differentiation appears limited, with a narrower potential role described around identifying nonviable tissue and intraoperative application.