Intraoperative free jejunum flap monitoring with indocyanine green near-infrared angiography

Abstract

The free jejunum flap technique has been regarded as the optimal approach during circumferential pharyngolaryngectomy reconstruction.Although classical patency tests are available, an intraoperative guarantee of the patency of anastomoses and microcirculations is inevitable.Indocyanine green near-infrared angiography (ICGA) was intraoperatively performed in six patients after reconstruction using the free jejunum flap.An adequate arterial as well as venous phase were observed. In addition to classical patency tests and doppler, we have successfully monitored the flap after total pharyngolalyngectomy intraoperatively using the ICGA. Our preliminary results implicate that this novel technique offers secure intraoperative monitoring of a free jejunum graft. This technique will provide us with advantages over regular patency test in selected cases.

The Use of Indocyanine Green Angiography for Cosmetic and Reconstructive Assessment in the Head and Neck

“…28 In a study on free jejunum transfer after circumferential pharyngolaryngectomy, it was highlighted that the value of postoperative monitoring of buried free flaps after wound closure is more predictive than intraoperative monitoring in identifying vascular compromise. 27 This increases the guarantee of flap survival, particularly in high-risk patients, 41 and salvage reconstruction. 42 Recently, ICG angiography has also been used in assessing successful free nerve grafting to the head and neck.…”

Indocyanine green fluorescence imaging ensures perfusion of the remnant stomach during laparoscopic splenectomy in a patient after distal gastrectomy: A case report

“…Conventionally, intraoperative evaluation of blood flow to organs was based on the color tone of the organs wall and the presence or absence of bleeding and arterial pulsation. However, ICG fluorescence imaging, which observe the organs using a camera with near-infrared light after intravenous injection of ICG, can confirm blood flow to organs with fluorescence, clearly delineating the boundary between areas with good and poor perfusion [ [8] , [9] , [10] , [11] ]. In our case, ICG fluorescence imaging was performed to visualize the blood flow and vascular distribution in the remnant stomach.…”

Application of Indocyanine Green in Flap Surgery: A Systematic Review

“…Compromised arterial supply and venous drainage cause postoperative complications, such as flap necrosis. 21,22 Murono et al 21 found that the intrinsic transit time of the flap, which was defined as the period from when the dye appeared at the arterial anastomosis until it reached the suture line of the venous anastomosis, was $10 seconds in six free jejunum flaps. Holzbach et al 23 90.0 seconds is a suggested threshold for identifying venous delay and pre-emptively assisting venous drainage via supercharging.…”

“…We found 29 articles introducing a potential dosing protocol for ICG (►Fig. 2), 1,11,16,21,22,[26][27][28][29][31][32][33]35,39,[44][45][46][47][48][49][50][51][52][53][54][55][56] and a total dose of 12.5 mg was the most frequently used intravenous dose. The second and third most frequently used intravenous doses were 7.5 mg total and 0.5 mg/kg (weight) , respectively.…”

“…A severe adverse reaction involved cardiac, respiratory, and neurologic systems. 5,58 We have found 74 articles referring to the application of ICG fluorescence imaging in flap surgery of which, 87.8% (65 cases) did not mention preoperative allergy testing 8,10,12,16,17,[19][20][21][22][23][24][25][26]29,30,32,33,35,39,42,44,45,[47][48][49][50][51][52][54][55][56] ; 9.5% (7 cases) only reported preoperative iodine allergy test 26,28,46,53,[94][95][96] ; and 2.7% (2 cases) conducted both an iodine allergy test and ICG allergy test 5,57 (►Fig. 3).…”