APPLICATION VALUE OF INDOCYANINE GREEN ANGIOGRAPHY IN FLAP RECONSTRUCTIVE SURGERY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANGKai , MULan , LIUYan , PENGZhe ,  LIGuangxue

Department of Aesthetic Surgery, Peking University People's Hospital, Beijing, 100044, P. R. China;

Corresponding author：

LIGuangxue, Email: luckylgx1012@163.com

Keywords：

Indocyanine green; Angiography; Flap; Complication

DOI：

10.7507/1002-1892.20150241

Video：

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Objective To investigate the utility of indocyanine green angiography in flap reconstructive surgery and possibility of decrease the complications. Methods Indocyanine green angiography was performed on 14 patients undergoing flap reconstructive surgery between February and December 2014 to evaluate the blood perfusion of the flap and to adjust the operation plan. Of 14 cases, 2 were male and 12 were female, aged 23-58 years (mean, 35.5 years); 11 flaps were used for breast reconstruction [including 3 free deep inferior epigastric antery perforator (DIEP) flaps, 4 pedicled transverse rectus abdominis myocutaneous flaps (TRAM), 2 pedicled TRAM and free TRAM, and 2 pedicled latissimus dorsi myocutaneous flaps and prosthesis], 1 pedicled latissimus dorsi myocutaneous flap for repairing chest wall defect, 1 pedicled profunda artery perforator (PAP) flap for upper leg defect, and 1 pedicled descending genicular artery perforator flap for knee defect. The size of the flaps ranged from 9 cm×6 cm to 26 cm×12 cm. Results A total of 32 indocyanine green angiography were performed. There was no adverse reactions to the infusion of indocyanine green. The surgery management was adjusted according to results of indocyanine green angiography findings in 5 of 14 cases. The distal part of flap were discarded because of poor perfusion in 3 cases (1 DIEP flap, 1 TRAM, and 1 PAP flap) and the other 2 cases (pedicled TRAM) needed additional free anastomosis to ensure sufficient blood supply (pedicled TRAM and free TRAM); the other flaps were harvested according to preoperative plan and repaired defect successfully. The mean follow-up was 5 months (range, 1-9 months). The other flaps survived without infection or fat necrosis except 1 PAP flap with distal necrosis. Conclusion Intraoperative indocyanine green angiography can provide real-time information of flap perfusion and then the operation plan can be adjusted in time to ensure the flap survival.

Citation： YANGKai, MULan, LIUYan, PENGZhe, LIGuangxue. APPLICATION VALUE OF INDOCYANINE GREEN ANGIOGRAPHY IN FLAP RECONSTRUCTIVE SURGERY. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(9): 1113-1116. doi: 10.7507/1002-1892.20150241 Copy

1.	Klasson S, Svensson H, Malm K, et al. Preoperative CT angiography versus Doppler ultrasound mapping of abdominal perforator in DIEP breast reconstructions:A randomized prospective study. J Plast Reconstr Aesthet Surg, 2015, 68(6):782-786.
2.	唐涛, 周鹏, 王朝晖, 等. CT血管成像三维重建技术在股前外侧穿支皮瓣修复头颈肿瘤术后缺损的应用. 中华耳鼻咽喉头颈外科杂志, 2015, 50(5):383-387.
3.	Swanson EW, Hsu YC, Cheng HT. CTA and contrast-enhanced MRA are equally accurate for localizing deep inferior epigastric perforator flap arteries:a systematic review. J Plast Reconstr Aesthet Surg, 2015, 68(4):580-581.
4.	Kagen AC, Hossain R, Dayan E, et al. Modern perforator flap imaging with high-resolution blood pool MR angiography. Radiographics, 2015, 35(3):901-915.
5.	Tuinder S, Baetens T, De Haan MW, et al. Septocutaneous tensor fasciae latae perforator flap for breast reconstruction:radiological considerations and clinical cases. J Plast Reconstr Aesthet Surg, 2014, 67(9):1248-1256.
6.	Olivier WA, Hazen A, Levine JP, et al. Reliable assessment of skin flap viability using orthogonal polarization imaging. Plast Reconstr Surg, 2003, 112(2):547-555.
7.	Holm C, Mayr M, Höfter E, et al. Intraoperative evaluation of skinflap viability using laser-induced fluorescence of indocyanine green. Br J Plast Surg, 2002, 55(8):635-644.
8.	Pestana IA, Coan B, Erdmann D, et al. Early experience with fluorescent angiography in free-tissue transfer reconstruction. Plast Reconstr Surg, 2009, 123(4):1239-1244.
9.	Holm C, Tegeler J, Mayr M, et al. Monitoring free flaps using laser-induced fluorescence of indocyanine green:a preliminary experience. Microsurgery, 2002, 22(7):278-287.
10.	Komorowska-Timek E, Gurtner GC. Intraoperative perfusion mapping with laser-assisted indocyanine green imaging can predict and prevent complications in immediate breast reconstruction. Plast Reconstr Surg, 2010, 125(4):1065-1073.
11.	Duggal CS, Madni T, Losken A. An outcome analysis of intraoperative angiography for postmastectomy breast reconstruction. Aesthet Surg J, 2014, 34(1):61-65.
12.	Taylor SR, Jorgensen JB. Use of fluorescent angiography to assess donor site perfusion prior to free tissue transfer. Laryngoscope, 2015, 125(6):E192-197.
13.	Rübben A, Eren S, Krein R, et al. Infrared videoangiofluorography of the skin with indocyanine green-rat random cutaneous flap model and results in man. Microvasc Res, 1994, 47(2):240-251.
14.	Matsui A, Lee BT, Winer JH, et al. Predictive capability of nearinfrared fluorescence angiography in submental perforator flap survival. Plast Reconstr Surg, 2010, 126(5):1518-1527.

1. Klasson S, Svensson H, Malm K, et al. Preoperative CT angiography versus Doppler ultrasound mapping of abdominal perforator in DIEP breast reconstructions:A randomized prospective study. J Plast Reconstr Aesthet Surg, 2015, 68(6):782-786.
2. 唐涛, 周鹏, 王朝晖, 等. CT血管成像三维重建技术在股前外侧穿支皮瓣修复头颈肿瘤术后缺损的应用. 中华耳鼻咽喉头颈外科杂志, 2015, 50(5):383-387.
3. Swanson EW, Hsu YC, Cheng HT. CTA and contrast-enhanced MRA are equally accurate for localizing deep inferior epigastric perforator flap arteries:a systematic review. J Plast Reconstr Aesthet Surg, 2015, 68(4):580-581.
4. Kagen AC, Hossain R, Dayan E, et al. Modern perforator flap imaging with high-resolution blood pool MR angiography. Radiographics, 2015, 35(3):901-915.
5. Tuinder S, Baetens T, De Haan MW, et al. Septocutaneous tensor fasciae latae perforator flap for breast reconstruction:radiological considerations and clinical cases. J Plast Reconstr Aesthet Surg, 2014, 67(9):1248-1256.
6. Olivier WA, Hazen A, Levine JP, et al. Reliable assessment of skin flap viability using orthogonal polarization imaging. Plast Reconstr Surg, 2003, 112(2):547-555.
7. Holm C, Mayr M, Höfter E, et al. Intraoperative evaluation of skinflap viability using laser-induced fluorescence of indocyanine green. Br J Plast Surg, 2002, 55(8):635-644.
8. Pestana IA, Coan B, Erdmann D, et al. Early experience with fluorescent angiography in free-tissue transfer reconstruction. Plast Reconstr Surg, 2009, 123(4):1239-1244.
9. Holm C, Tegeler J, Mayr M, et al. Monitoring free flaps using laser-induced fluorescence of indocyanine green:a preliminary experience. Microsurgery, 2002, 22(7):278-287.
10. Komorowska-Timek E, Gurtner GC. Intraoperative perfusion mapping with laser-assisted indocyanine green imaging can predict and prevent complications in immediate breast reconstruction. Plast Reconstr Surg, 2010, 125(4):1065-1073.
11. Duggal CS, Madni T, Losken A. An outcome analysis of intraoperative angiography for postmastectomy breast reconstruction. Aesthet Surg J, 2014, 34(1):61-65.
12. Taylor SR, Jorgensen JB. Use of fluorescent angiography to assess donor site perfusion prior to free tissue transfer. Laryngoscope, 2015, 125(6):E192-197.
13. Rübben A, Eren S, Krein R, et al. Infrared videoangiofluorography of the skin with indocyanine green-rat random cutaneous flap model and results in man. Microvasc Res, 1994, 47(2):240-251.
14. Matsui A, Lee BT, Winer JH, et al. Predictive capability of nearinfrared fluorescence angiography in submental perforator flap survival. Plast Reconstr Surg, 2010, 126(5):1518-1527.

Chinese Journal of Reparative and Reconstructive Surgery

APPLICATION VALUE OF INDOCYANINE GREEN ANGIOGRAPHY IN FLAP RECONSTRUCTIVE SURGERY

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