Intraoperative Near-infrared Fluorescence Imaging in Perforator Flap Reconstruction: Current Research and Early Clinical Experience

Abstract

Despite recent advances in perforator flap reconstruction, there can be significant variability in vessel size and location. Although pre-operative evaluation may provide valuable information, real-time intraoperative methods have the potential to provide the greatest benefit. Our laboratory has developed the Fluorescence-Assisted Resection and Exploration (FLARE™) near-infrared (NIR) fluorescence imaging system for visualizing, intraoperatively, details of the underlying vasculature. The FLARE™ system uses indocyanine green, a safe and reliable NIR fluorophore already FDA-approved for other indications. The system has been optimized in large animal models for the identification of perforator size, location, and perfusion, and has also been translated to the clinic for use during breast reconstruction after mastectomy. In this paper, we review our pre-clinical and clinical data, as well as literature describing the use of similar NIR fluorescence imaging systems in plastic and reconstructive surgery.

Tracer agents for the detection of sentinel lymph nodes in breast cancer: Current concerns and directions for the future

“…Indocyanine green is a fluorescing reagent used for intraoperative visualization of vascular patency in neuroangiography [36], cardiovascular surgery [37], and solid organ transplantation [38], and plastic and reconstructive surgery [39]. A tricarbocyanine dye that appears dark green in natural light, indocyanine green absorbs light in the near-infrared range and emits maximum fluorescence at a wavelength of 840 nm when bound to plasma proteins.…”

Image guided surgery in the management of head and neck cancer

“…ICG has a short lifetime in the blood (2-4 min plasma half-life) and slow plasma clearance rate once bound to the plasma proteins [15]. Earlier, ICG was used to assess cardiac and liver functions and lately, its applications have been diversified to visualize bile ducts, vascular networks, and demarcation of liver segments [16][17][18][19]. Although various NIR fluorescent contrast agents have been developed and tested in preclinical studies only ICG is approved by the FDA for fluorescence imaging [20].…”

The Effect of Platelete Rich Plasma Combined with Microneedling on Full Venous Outflow Compromise in a Rat Skin Flap Model

“…1 We recently reported that affected subcutaneous adipose tissue in patients with FIL contains mutant cells with somatic gain-offunction mutations in PIK3CA. 2 The purpose of this study was to determine whether other affected tissues in FIL also contain mutant cells.…”