Indocyanine green fluorescence angiography for free flap monitoring: A pilot study

Hitier, Marine; Cracowski, Jean‐Luc; Hamou, Cynthia; Righini, Christian; Bettega, G.

doi:10.1016/j.jcms.2016.09.001

Cited by 60 publications

(46 citation statements)

References 23 publications

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“…The technique for ICG-videoangiography as well as for O2C measurements are described elsewhere in detail 8,20-22 . The technical and clinical advantages of objective monitoring methods are generally obvious and well described, but most studies are focussing on the qualitative value of visualization of patency of microvascular www.nature.com/scientificreports www.nature.com/scientificreports/ anastomosis or tissue perfusion alone 14,23 . While most other studies focus on qualitative observations, we included a highly sophisticated statistical analysis based on machine learning (Random Forest prediction model) to compare the importance of each individual parameter that was quantitatively registered by each analysed modality.…”

Section: Discussionmentioning

confidence: 99%

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A comparative analysis using flowmeter, laser-Doppler spectrophotometry, and indocyanine green-videoangiography for detection of vascular stenosis in free flaps

Mücke

Hapfelmeier

Schmidt

et al. 2020

Sci Rep

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The effects of gradual vascular occlusion on the blood supply of perfused areas are poorly described. Information relating to the comparison of flap monitoring techniques is lacking. Varying stenotic conditions (0%, 25%, 50%, 75% and 100%) were generated on purpose at the A. and V. femoralis in the rat model. Analyses included flowmeter, simultaneous laser-Doppler flowmetry and tissue spectrophotometry (O2C) and indocyanine green-(ICG-) videoangiography with integrated FLOW 800 tool. A Random Forests prediction model was used to analyse the importance of each method to diagnose the stenotic conditions. The ability to discriminate and to accurately estimate the probability of stenosis was assessed by Receiver Operating Characteristic (ROC) curves and calibration plots. Blood flow changes for all modalities were described in detail. Flowmeter displayed earliest a linear decrease as a result of increasing stenosis. A stenosis of 50% degrees was most difficult to detect correctly. The combination of flowmeter and ICG-videoangiography showed high diagnostic power for each stenotic situation (area under the Roc > 0.79). Flowmeter and ICG-videoangiography showed to be most relevant in detection of varying stenotic conditions and may change the clinical outcome. The O2C showed less effect on varying stenotic situations as the only surface monitoring device. The microvascular free tissue transfer has revolutionised reconstructive microsurgery and has improved the patients' functional outcome 1. Despite the well documented co-morbidities of patients undergoing head and neck surgery, free flap surgery has contributed to a continuous improvement in the patient-reported and clinical outcomes 2-4. Due to the significant patient co-morbidities and the complexity of the operations, this patient cohort has a high free flap failure rate. A successful outcome necessitates a detailed pre-, intra-and postoperative patient screening in addition to the free flap monitoring, for at least the first 72 hours, postoperatively. The reasons for free flap failures are commonly vascular (thrombosis, endothelial damage) or extravascular, (hematoma, kinking, twisting) in origin. Flap necrosis invariably leads to a prolonged hospital stay and may result in mortality due to poor physiological reserves. There is a definitive window of surgical intervention that must not be missed, for the salvage operation to be successful 5,6. For this reason, the routine postoperative free flap monitoring has to be effective, reproducible and reliable. Free flap monitoring techniques vary and may include the clinical observation, pinprick testing and handheld Doppler 7. More sophisticated, objective methods include simultaneous

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Section: Discussionmentioning

confidence: 99%

“…www.nature.com/scientificreports www.nature.com/scientificreports/ laser-Doppler flowmetry and tissue spectrophotometry, tissue oximetry monitoring, infrared thermography and indocyanine green-(ICG-) videoangiography [8][9][10][11][12][13][14][15] .…”

mentioning

confidence: 99%

A comparative analysis using flowmeter, laser-Doppler spectrophotometry, and indocyanine green-videoangiography for detection of vascular stenosis in free flaps

Mücke

Hapfelmeier

Schmidt

et al. 2020

Sci Rep

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“…There is no high-quality data to explain why vasospasm would occur in a delayed fashion and how best to manage it in a microsurgical setting. 14 Postoperative arterial vasospasm is well-described and documented in cardiac and neurological surgery, where irreversible and life-threatening consequences may result. 4 Vasospasm in these cases is managed differently from that encountered in microsurgical free tissue transfer, with the mainstay of therapy being intraluminal injection of vasodilating agents via angiography and/or the administration of systemic vasodilators.…”

Section: Discussionmentioning

confidence: 99%

Current Practices in the Management of Postoperative Arterial Vasospasm in Microsurgery

Turin

Walton

Dumanian

et al. 2017

J reconstr Microsurg

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When flap ischemia is encountered without mechanical issues or thrombus, vasospasm can be the root cause. Certain vessels (SIEA, STA) and anatomic regions (lower limb) pose a higher risk for this phenomenon. When a vessel is affected, it is common practice to excise the questionable segment and use a graft as needed. Vessel resection as part of a multimodal approach can result in a reasonable salvage rate.

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“…Other methods of noninvasive monitoring of free flaps include near-infrared spectroscopy and indocyanine green angiography. 15,16 Postoperative nutrition using nasogastric, nasojejunal, or gastrostomy tubes is commonly needed in patients undergoing mandibular reconstruction. Adequate nutrition with amino acids and carbohydrates is necessary for recovery and healing.…”

Section: Perioperative Care Of the Mandibular Reconstruction Patientmentioning

confidence: 99%

Free-Flap Reconstruction of the Mandible

Kim

Sokoya

Ducic

et al. 2019

Seminars in Plastic Surgery

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Mandible reconstruction has evolved over the years with advances in surgical options and three-dimensional technology. Although nonvascularized bone grafting is still used, vascularized flaps show advantages with immediate reconstruction, the possibility of immediate dental implants, and the ability to reconstruct composite defects of both soft tissue and bone. This article discusses current vascularized techniques for mandible reconstruction. While each reconstructive method has advantages and disadvantages, a defect-based reconstruction focused on full rehabilitation allows surgeons to plan and counsel the patient for the best available reconstruction.

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Indocyanine green fluorescence angiography for free flap monitoring: A pilot study

Cited by 60 publications

References 23 publications

A comparative analysis using flowmeter, laser-Doppler spectrophotometry, and indocyanine green-videoangiography for detection of vascular stenosis in free flaps

A comparative analysis using flowmeter, laser-Doppler spectrophotometry, and indocyanine green-videoangiography for detection of vascular stenosis in free flaps

Current Practices in the Management of Postoperative Arterial Vasospasm in Microsurgery

Free-Flap Reconstruction of the Mandible

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