A review finds indocyanine green fluorescence can guide anatomy and tissue perfusion in acute surgery, with the strongest clinical support for reducing anastomotic leaks.

• Potential uses span biliary and ureteric mapping, bowel perfusion assessment, trauma, and soft-tissue debridement.
• The review cites WSES consensus and a SAGES meta-analysis as the strongest evidence to date for anastomotic leak reduction, but provides no effect size.

ICG may be a useful adjunct when equipment and expertise are available—not a replacement for clinical judgment.

• Acute-care dosing is not standardized, fluorescence interpretation remains subjective, and randomized evidence is limited.