Utility of Indocyanine Green Fluorescence Imaging in Burn Management: A Systematic Review

The implementation of near-infrared fluorescence (NIRF) imaging using indocyanine green (ICG) has seen a rising implementation in burn care in recent years, with expanding clinical indications and increasing evidence supporting its use. A systematic review was carried out following PRISMA guidelines, employing PubMed, Web of Science, CINAHL, and EMBASE databases to locate studies on the perioperative use of ICG in burn patients. Two independent reviewers assessed all articles for eligibility based on predefined inclusion criteria. Extracted data included study characteristics, patient demographics, clinical indications, ICG dosing regimens, administration timing, and reported perioperative outcomes. A total of 12 studies enrolling 204 burn patients, published between 1995 and 2025, were included for qualitative synthesis. Of these, 7 (58.3%) were prospective, single-center experimental studies; 3 (25%) were prospective, multicenter, blinded trials; 1 (8.3%) was a retrospective study; and 1 (8.3%) was a case series. The primary clinical uses of ICG in burn management included: assessment of burn depth reported in 6 studies, intraoperative delineation of necrotic tissue requiring excision in 3 studies, utility of ICG in liver function measurement in 2 studies and another research analyzed the estimation of plasma volume in burn patients. ICG fluorescence imaging is a promising adjunctive tool for burn assessment, particularly in identifying non-perfused tissue. It enhances the ability to accurately assess burn depth and helps to determine surgical margins during burn excision. Furthermore, ICG pharmacokinetics may provide insight into liver involvement and prognostic outlook in severe burn cases. However, its current role remains complementary to clinical evaluation. Further standardized and high-quality studies are required to define its diagnostic accuracy and clinical impact.