Evaluation of the vascular integrity of free flaps based on microcirculation imaging techniques

Lamby, Philipp; Prantl, Lukas; Gais, S.; Walter, Miriam; Bachthaler, Maike; Nerlich, Michael; Feuerbach, Stefan; Jung, Ernst Michael

doi:10.3233/ch-2008-1094

Cited by 25 publications

(11 citation statements)

References 14 publications

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“…Indeed, fluorescein‐enhanced capillaroscopy improves contrast and provides an index of capillary permeability. This technique has been used to study the influence of age on microcirculation [75] and in various diseases including diabetes [10], systemic sclerosis [60], psoriasis [16], or to evaluate the vascular integrity of skin flaps [43,83]. This technique, however, is increasingly replaced by OPS and SDF imaging (see below), which are safer, non‐invasive, and provide better contrast.…”

Section: Optical Microscopy‐derived Techniquesmentioning

confidence: 99%

Non‐invasive Assessment of Skin Microvascular Function in Humans: An Insight Into Methods

2011

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For more than two decades, methods for the non-invasive exploration of cutaneous microcirculation have been mainly based on optical microscopy and laser Doppler techniques. In this review, we discuss the advantages and drawbacks of these techniques. Although optical microscopy-derived techniques, such as nailfold videocapillaroscopy, have found clinical applications, they mainly provide morphological information about the microvessels. Laser Doppler techniques coupled with reactivity tests are widespread in the field of microvascular function research, but many technical issues need to be taken into account when performing these tests. Post-occlusive reactive hyperemia and local thermal hyperemia have been shown to be reliable tests, although their underlying mechanisms are not yet fully understood.Acetylcholine and sodium nitroprusside iontophoresis, despite their wide use as specific tests of endothelium-dependent and -independent function, respectively, show limitations. The influence of the skin site, recording conditions, and the way of expressing data are also reviewed.Finally, we focus on promising tools such as laser speckle contrast imaging.Key words: microcirculation, capillaroscopy, laser Doppler, laser speckle, iontophoresis, local thermal hyperemia, post-occlusive hyperemia WHY AND HOW TO ASSESS SKIN MICROVASCULAR FUNCTION?Since the development of methods allowing the study of microcirculation, microvascular dysfunction has been associated with several vascular diseases as well as in aging [100]. The role of generalized microvascular dysfunction in the pathophysiology or as a consequence of these diseases has also been questioned. Indeed, patients with impaired coronary microvascular function also have evidence of impaired peripheral microvascular function, suggesting a generalized disorder in the regulation of the microvasculature [120]. Similar findings have been reported of correlated abnormalities between cutaneous and retinal microvasculature in diabetic patients [20].As the skin is readily accessible, it provides an appropriate site to assess peripheral microvascular reactivity. Moreover, recent technological advances have provided simple and non-invasive methods to assess skin microvascular function. Therefore, human cutaneous circulation could be used as a surrogate marker of systemic microvascular function in various diseases. However, this raises the issue of how representative the microcirculation in the skin is to the microcirculation in other organs. To date, the skin has been used as a model of microcirculation to investigate vascular mechanisms in a variety of diseases, including

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Section: Optical Microscopy‐derived Techniquesmentioning

confidence: 99%

Non‐invasive Assessment of Skin Microvascular Function in Humans: An Insight Into Methods

2011

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“…Reconstructive surgery often requires a free flap to be harvested from a donor site. A free flap is defined as a graft of free tissue transferred from another site to cover the injured site 80. Although the success rate exceeds 90%, the serious complication of flap failure still exists 81.…”

Section: Free Flapsmentioning

confidence: 99%

Current trends and emerging future of indocyanine green usage in surgery and oncology

Połom

Murawa

Rho

et al. 2011

Cancer

224

172

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Ever since Kitai first performed fluorescent navigation of sentinel lymph nodes (SLNs) using indocyanine green (ICG) dye with a charge-couple device and light emitting diodes, the intraoperative use of near infrared fluorescence has served a critical role in increasing our understanding in various fields of surgical oncology. Here the authors review the emerging role of the ICG fluorophore in the development of our comprehension of the lymphatic system and its use in SLN mapping and biopsy in various cancers. In addition, they introduce the novel role of ICG-guided video angiography as a new intraoperative method of assessing microvascular circulation. The authors attempt to discuss the promising potential in addition to assessing several challenges and limitations in the context of specific surgical procedures and ICG as a whole. PubMed and Medline literature databases were searched for ICG use in clinical surgical settings. Despite ICG's significant impact in various fields of surgical oncology, ICG is still in its nascent stages, and more in-depth studies need to be carried out to fully evaluate its potential and limitations. Cancer 2011;117:4812-22. V C 2011 American Cancer Society.KEYWORDS: sentinel lymph node, indocyanine green, lymphedema, free flaps, axillary reverse mapping, sentinel lymph node biopsy.Near infrared (NIR; emission spectra of $700-850 nm) 1 fluorophores are probes that have gained immense interest in various fields of biomedicine because of their minimal interfering absorption and fluorescence from biological samples, inexpensive laser diode excitation, reduced scattering, and enhanced tissue penetration depth. 2 However, to date, only 1 NIR probe, indocyanine green (ICG) has been approved by the US Food and Drug Administration (FDA); methylene blue is another FDA-approved probe that displays NIR properties, however, it is not considered a pure NIR probe. The former, ICG, is a water-soluble, anionic, amphiphilic tricarbocyanine probe 3 with a hydrodynamic diameter of 1.2 nm, and excitation and emission wavelengths in serum at 778 and 830, respectively. 4,5 For several years, it has been used in ophthalmic angiography 6 and for determining cardiac output 7 and hepatic function. 8 However, it has only recently shown real practicability and feasibility in the field of surgical oncology. Three major domains where NIR-guided ICG fluorophores have appeared most promising are: 1) sentinel lymph node (SLN) detection, 2) evaluation of lymphedema, and 3) assessment of microvascular circulation of free flaps in reconstructive surgery. Although several reviews have discussed the importance of NIR fluorophores (including ICG), 9-13 in this review we limit our discussion specifically to ICG in an attempt to attain a better understanding of its impact and challenges it presents in the field of surgical oncology.Intraoperative SLN Mapping and Biopsy Using ICG The significance of cancer treatment management in relation to first lymphatic drainage from the tumor site, the SLN, was first proposed by Cabanas...

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“…Near infrared ICG-guided SNL mapping has been performed in various cancers as shown in Table 1 . ICG has also been used for lymphography ( 167 ), angiography ( 61 , 168 ), reconstructive surgery ( 65 , 67 ), cholangiography ( 71 ) and tumor imaging ( 99 ), and so on. The use of ICG for delineating tumors has been a success.…”

Section: Current Clinical Use Of Fluorescence Imaging Probesmentioning

confidence: 99%

Fluorescence-Guided Surgery

et al. 2017

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Surgical resection of cancer remains an important treatment modality. Despite advances in preoperative imaging, surgery itself is primarily guided by the surgeon’s ability to locate pathology with conventional white light imaging. Fluorescence-guided surgery (FGS) can be used to define tumor location and margins during the procedure. Intraoperative visualization of tumors may not only allow more complete resections but also improve safety by avoiding unnecessary damage to normal tissue which can also reduce operative time and decrease the need for second-look surgeries. A number of new FGS imaging probes have recently been developed, complementing a small but useful number of existing probes. In this review, we describe current and new fluorescent probes that may assist FGS.

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Evaluation of the vascular integrity of free flaps based on microcirculation imaging techniques

Cited by 25 publications

References 14 publications

Non‐invasive Assessment of Skin Microvascular Function in Humans: An Insight Into Methods

Non‐invasive Assessment of Skin Microvascular Function in Humans: An Insight Into Methods

Current trends and emerging future of indocyanine green usage in surgery and oncology

Fluorescence-Guided Surgery

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