Fluorescein Test for Prediction of Flap Viability During Breast Reconstructions

Singer, Robert D.; Lewis, Carson M.; Franklin, John D.; Lynch, John B.

doi:10.1097/00006534-197803000-00010

Cited by 55 publications

(34 citation statements)

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“…Subsequently, a modified perfusion fluoremeter has been developed as a new method of assessing capillary blood flow [35]. Qualitative visual or quantitative fluorometric assessment of tissue fluorescence after intravenous injection of sodium fluorescein provides an index of fluorescein delivery that correlates with vascularity and viability in skin flaps [17][18][19] and ischaemic bowel [15,16]. Fluorescein flowmetry, as a technique of measuring changes in intestine blood flow correlates well with that obtained by electromagnetic flowmetry (r = 0.86) and 133Xenon clearance technique (r = 0.94) [36].…”

Section: Discussionmentioning

confidence: 99%

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Impaired blood flow and arterio-venous shunting in human diabetic neuropathy: a novel technique of nerve photography and fluorescein angiography

et al. 1993

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Summary. New techniques of sural nerve photography and fluorescein angiography which are able to provide an index of nerve blood flow have been developed. Under local anaesthetic, 3 cm of sural nerve was exposed at the ankle using an operating microscope. Without disturbing the epineurium, vessels were identified and photographed at a standard magnification ( x 30). These were independently graded by an ophthalmologist not otherwise involved with the study. Fluorescein angiography was then carried out on the exposed nerve. The fluorescein appearance time and intensity of fluorescence were quantified, using computer analysis of digitised images. Thirteen subjects with chronic sensory motor neuropathy, five non-neuropathic diabetic and nine normal control subjects were studied. The mean epineurial vessel pathology score of the neuropathic group was significantly higher than the combined normal control and non-neuropathic diabetic groups (p < 0.01). Direct epineurial arteriovenous shunting was observed in six neuropathic and one non-neuropathic diabetic patients and not in any of the normal control subjects. The nerve fluorescein appearance time was significantly delayed in subjects with chronic sensory motor neuropathy (51.5 + 12 s) compared to both normal (34.7 _+ 9 s, p < 0.01) and non-neuropathic diabetic subjects (33.4 + 11 s,p < 0.025). The mean intensity of fluorescence at 96, 252 and 576 s, was significantly lower in subjects with chronic sensory motor neuropathy compared with both of the other groups (p < 0.05). The epineurial vessel pathology score was significantly related to reduced sural (p < 0.01) and peroneal (p < 0.001) nerve conduction velocities, elevated vibration (p < 0.01) and thermal (p < 0.001) perception and the severity of retinopathy (p < 0.002). The fluorescein appearance time was significantly related to reduced sural sensory (p <0.02) conduction velocity, elevated vibration (p < 0.01) perception and epineurial vessel (p < 0.002) pathology score, but it failed to relate to peroneal motor (p = 0.06) conduction velocity, thermal (p = 0.1) perception and the severity ofretinopathy (p = 0.3). Intensity of fluorescence was significantly related to fluorescein appearance time (at 96 s,p < 0.001; at 576 s,p < 0.05) but did not relate to measures of neuropathic severity. These techniques have enabled us to observe that epineurial vessel anatomy is abnormal and that nerve blood flow is impaired in subjects with chronic sensory motor neuropathy. In addition epineurial arterio-venous shunting may be a feature of diabetic neuropathy. These techniques may further be applied to study nerve blood flow in early diabetic neuropathy.

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Section: Discussionmentioning

confidence: 99%

“…However, almost all our current knowledge of diabetic neuropathy stems from studies on animal models and [14][15][16][17][18][19][20], was applied to provide an index of nerve blood flow. These techniques have enabled us to observe epineurial arterio-venous shunting and impaired nerve blood flow in human diabetic neuropathy.…”

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confidence: 99%

Impaired blood flow and arterio-venous shunting in human diabetic neuropathy: a novel technique of nerve photography and fluorescein angiography

et al. 1993

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“…30 Its utility in assessing the blood flow to skin flaps was first described in 1962 by M. Bert Myers, who demonstrated the effectiveness of the routine use of intravenous fluorescein in predicting and preventing skin slough following mastectomy. 31,32 In 1977, Singer et al showed that the fluorescein test was a useful ancillary procedure for predicting skin flap viability in cases of immediate breast reconstruction with implants, although they noted that the test had a tendency to overpredict the area of necrosis.…”

Section: Discussionmentioning

confidence: 99%

“…31,32 In 1977, Singer et al showed that the fluorescein test was a useful ancillary procedure for predicting skin flap viability in cases of immediate breast reconstruction with implants, although they noted that the test had a tendency to overpredict the area of necrosis. 30 Its utility in cases of skinsparing mastectomy and autologous reconstruction was demonstrated by Losken et al in a series of 50 patients in 2008. 13 Intraoperative imaging using laser-assisted indocyanine green offers several theoretical advantages over intravenous fluorescein.…”

Section: Discussionmentioning

confidence: 99%

“…This technique has been used in immediate breast reconstruction for many years, and has been demonstrated to be a sensitive test for determining native mastectomy flap viability. 12,13 Indocyanine green is a fluorescent cyanine dye that has been used in medical diagnostics since the 1950s. This dye, when excited by an 805-nm laser, emits fluorescence, which can be detected by a chargecoupled camera and shows a real-time image of tissue perfusion.…”

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A Comparison of Methods to Assess Mastectomy Flap Viability in Skin-Sparing Mastectomy and Immediate Reconstruction

Rinker

2016

Plastic and Reconstructive Surgery

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Survival of Myocutaneous Flaps: Experimental Evaluation by Intra-arterial Injection of a Dye

Nieto¹,

García²,

Gomis³

et al. 1985

Archives of Otolaryngology - Head and Neck Surgery

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\s=b\ Ninety-four myocutaneous island flaps of the pectoralis major were studied in the rabbit using sulfan blue (Disulphine\x=req-\ blue). In 13 cases, the dye was injected intra-arterially in the acromiothoracic artery before the flap was lifted, and 47 more were injected after the lifting of the flap. In 34 further cases, sulfan blue was injected intravenously once the flap had been lifted. In another 16 flaps, vascularization was studied by means of "diaphanization" (ie, making the tissue transparent or diaphenous in nature). In all groups, the surviving length of flap was observed to be greater than the stained length. Intra-arterial administration of sulfan blue was associated with reduced flap survival. Viable flap length was not related to the anatomy of the vascular base. (Arch Otolaryngol 1985;111:43-46) The viability of a myocutaneous flap depends on preserving its vascularity. Because of this, it is con¬ venient to evaluate the condition of the vascular bed at the time of sur¬ gery. One of the most practical meth¬ ods is the use of dyes, such as fluorescein and sulfan blue (Disulphineblue), injected intravenously (IV) into the vascular system. The reliability of these methods, however, is controver¬ sial because some authors have found a good correlation between the exten¬ sion of the colored and surviving areas14 while others have concluded that the surviving area is substantial¬ ly greater than the dye-stained area.5Sulfan blue was the dye used in this study. One advantage of using sulfan blue is that, unlike fluorescein, it does not require UV light for its évalua-

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Fluorescein Test for Prediction of Flap Viability During Breast Reconstructions

Cited by 55 publications

References 0 publications

Impaired blood flow and arterio-venous shunting in human diabetic neuropathy: a novel technique of nerve photography and fluorescein angiography

Impaired blood flow and arterio-venous shunting in human diabetic neuropathy: a novel technique of nerve photography and fluorescein angiography

A Comparison of Methods to Assess Mastectomy Flap Viability in Skin-Sparing Mastectomy and Immediate Reconstruction

Survival of Myocutaneous Flaps: Experimental Evaluation by Intra-arterial Injection of a Dye

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