The Impact of Indocyanine-Green Fluorescence Angiography on Intraoperative Decision-Making and Postoperative Outcome in Free Flap Surgery

Bigdeli, Amir K.; Thomas, Benjamin; Falkner, Frank; Gazyakan, Emre; Hirche, Christoph; Kneser, Ulrich

doi:10.1055/s-0040-1710552

Cited by 24 publications

(36 citation statements)

References 27 publications

(61 reference statements)

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“…39 Moreover, ICG, owing to its high sensitivity, specificity, and positive predictive value of tissue necrosis, has been shown to increase the rate of survival of different free flaps by refining surgical decision-making on flap design. 40 Additionally, the use of ICG has shown to predict possible internal jugular vein (IJV) thrombosis intraoperatively after free flaps anastomosis by reporting greater venous flow rates and subsequent ICG fluorescence time (reaching 18 seconds) than expected. 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.…”

Section: Icg Angiography: Results By Indication and Type Of Flap Freementioning

confidence: 99%

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

2020

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Reconstructive procedures in the head and neck can be a surgical challenge owing to the complex anatomical and physiological structure. Different locoregional and microvascular flaps are used for various defects to improve both function and cosmesis. Subjective clinical findings have been the mainstay for perfusion monitoring; however, areas of borderline perfusion are much more difficult to assess clinically. Multiple technologies that offer objective perfusion assessment have been developed to improve surgical outcomes. Indocyanine green (ICG) angiography has gained popularity owing to its minimal invasiveness and increased sensitivity and specificity in assessing flap perfusion particularly in the head and neck. It has been extensively used in free flaps, pedicled flaps (including nasal reconstruction), facelift procedures, random flaps, skull base reconstruction, and pharyngocutaneous fistula prediction. Its perioperative use has provided valuable qualitative and quantitative data that aid our understanding of flap hemodynamics. Clinically, this impacted decision-making in flap design, harvest, inset, and precocious salvage interventions. Though increased cost and intraoperative time could be limitations, cost-effectiveness studies have supported its use, particularly in high-risk individuals. Limitations include the lack of standardized dosing and consistent methodology agreement for data analysis. Future studies should involve larger cohorts and multi-institute studies to overcome such limitations.

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Section: Icg Angiography: Results By Indication and Type Of Flap Freementioning

confidence: 99%

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

2020

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“…Image-guided surgeries, performed after injecting ICG dye into blood vessels, have been used to delineate the cancer margin in urology, hepatobiliary, and colorectal surgery, as well as to explore sentinel nodes; there are also reports of robots being used in monitoring the flap pedicle (38)(39)(40). Da Vinci's camera has a built-in Near Infrared (NIR) system which can be activated simply by finger trigger.…”

Section: Discussionmentioning

confidence: 99%

Robot-assisted surgeries in oral and maxillofacial area: a narrative review on the present, advantages and its future

Kim¹,

Cho²,

Kim³

2022

Front Oral Maxillofac Med

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To survey the advantages, future prospects, and cases using robotic systems in oromaxillofacial surgery.Background: With the accumulation of advances in minimally invasive surgery in the entire body area, robot-assisted surgeries have become very common in operating rooms, despite of their short history. Thus, advances in robotic surgery are accelerating rapidly, particularly with respect to the maxillofacial region. In this regard, researchers reviewed the literatures using the keywords given below, including systematic metaanalysis.Methods: The report follows the format of the "narrative review" and reviewed literatures extracted from the PubMed database since 1980 when 'Robotic surgical procedures', 'neck dissection' and 'oral surgery' were searched.Conclusions: Robotic surgery in the oral and maxillofacial region allows the incision to hide the scar by making the incision line far from the surgical field, resulting in fewer intra-operative and post-operative complications, such as amount of drainage or hospital days. Furthermore, recent studies show similar or superior results in terms of oncologic safety of robot assisted surgeries compared to conventional surgeries.Robotic surgery is likely to extend throughout the oral and maxillofacial region once it becomes capable of manipulating bone such as in osteotomies, particularly as robotic systems become smaller. When combined with artificial intelligence technology, the surgical robot will become more useful and powerful in relieving human suffering.

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“…As in our case, perfusion in the distal part of the flap can be unreliable, and the extent of the potentially ischemic flap in need of resection is unknown in the absence of techniques such as ICG angiography. ICG allows for intraoperative decision-making when determining flap viability [19]. As a result, intraoperative ICG for muscle flaps has the potential to decrease the length of individual hospital stays and thus associated economic costs.…”

Section: Discussionmentioning

confidence: 99%

Use of Indocyanine Green Angiography for Real-Time Assessment of a Sternocleidomastoid Muscle Flap During Complex Facial Reconstruction

Montorfano¹,

Bordes²,

Cobos³

et al. 2021

Cureus

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Indocyanine green (ICG) angiography is a procedure that uses a fluorescent dye for a variety of medical diagnostics, including the real-time examination of blood flow in tissue. Herein, we report a case in which ICG angiography was used to assess the viability of a sternocleidomastoid (SCM) muscle flap during postparotidectomy facial reconstruction. To our knowledge, this is the first report documenting the intraoperative use of ICG for the evaluation of SCM flap perfusion. ICG angiography may prove beneficial for cases involving complex reconstructions and suspected organ hypoperfusion.

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The Impact of Indocyanine-Green Fluorescence Angiography on Intraoperative Decision-Making and Postoperative Outcome in Free Flap Surgery

Cited by 24 publications

References 27 publications

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

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

Robot-assisted surgeries in oral and maxillofacial area: a narrative review on the present, advantages and its future

Use of Indocyanine Green Angiography for Real-Time Assessment of a Sternocleidomastoid Muscle Flap During Complex Facial Reconstruction

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