Intraoperative indocyanine green fluorescent angiography‐assisted modified superior gluteal artery perforator flap for reconstruction of sacral pressure sores

Abstract

Pressure sores are often observed in patients who are bedridden. They can be a severe problem not only for patients and their caregivers but also for plastic surgeons. Here, we describe a new method of superior gluteal artery perforator flap harvesting and anchoring with the assistance of intraoperative indocyanine green fluorescent angiography. In this report, we describe the procedure and outcomes for 19 patients with grades III and IV sacral pressure sores who underwent the operation between September 2015 and November 2016. All flaps survived, and two experienced wound-edge partial dehiscence. With the assistance of this imaging device, we were able to acquire a reliable superior gluteal artery perforator flap and perform modified operations with it that are safe, easy to learn and associated with fewer complications than are traditional.

Surgical treatment and strategy in patients with multiple pressure sores

“…Consequently, in treating trochanteric pressure sores, we preferred to utilise hatchet‐shaped TFL flaps for a smaller defect and pALT flaps for a larger defect. Our previous studies showed that a modified SGAP flap with less dissection of the perforator and assistance of intraoperative indocyanine green fluorescent angiography provides a shorter operative time and lesser bleeding, which make the SGAP flaps an excellent choice for sacral sore coverage . As a result, in sacrum pressure sore management, we preferred to utilise V‐Y advancement flap for a smaller defect and SGAP for a larger defect.…”

“…Our previous studies showed that a modified SGAP flap with less dissection of the perforator and assistance of intraoperative indocyanine green fluorescent angiography provides a shorter operative time and lesser bleeding, which make the SGAP flaps an excellent choice for sacral sore coverage. 11,12 As a result, in sacrum pressure sore management, we preferred to utilise V-Y advancement flap for a smaller defect and SGAP for a larger defect. In ischium pressure sores, the defect is usually deep, and delayed primary closure often leads to high recurrence and complication rates.…”

“…Vacuum‐assisted closure (VAC) has an important role in pressure sore management as a bridge to future surgery. In the case of sacrum pressure sores, we preferred a superior gluteal artery perforator (SGAP) flap for a larger defect and V‐Y fasciocutaneous flap for a smaller defect. For a trochanteric defect, we preferred a pedicled anterolateral thigh (pALT) myocutaneous flap for a larger defect and a hatchet‐shaped tensor fascia lata (TFL) flap for a smaller defect.…”

Leveraging Engineering of Indocyanine Green-Encapsulated Polymeric Nanocomposites for Biomedical Applications

“…In another study, Kaneko et al examined the effect of ICG in human hepatocarcinoma cells (HuH-7 and HepG2 cell line), demonstrating that the NIR could penetrate the deeper parts of the tumor [ 136 ]. The penetration depth was reported from 10 mm to several centimeters [ 128 , 146 , 147 ]. Moreover, the major portion of the absorbed light (~88%) is converted to heat under PTT and singlet oxygen generation via PDT elicits cancer cell destruction [ 137 ].…”

“…Unilateral revascularization procedures using ICG ( Figure 8 a(iii)) significantly reflected the increase/decrease of perfusion in the treated/contralateral limb and reduction in the contralateral foot circulation [ 84 ]. With the help of intraoperative ICG fluorescence angiography, Chang et al described a method of a superior gluteal artery perforator flap that was safer, easier, and had fewer complications [ 43 , 85 , 147 ].…”