Use of Intraoperative Fluorescent Angiography to Assess and Optimize Free Tissue Transfer in Head and Neck Reconstruction

Green, J. Marshall; Thomas, Shane; Sabino, Jennifer; Howard, Robert T.; Basile, Patrick; Dryden, Steven; Crecelius, Chris; Valerio, Ian L.

doi:10.1016/j.joms.2013.01.019

Cited by 38 publications

(56 citation statements)

References 26 publications

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“…After the administration of ICG, the compound absorbs photons at 806 nm, thus exciting ICG electrons which emit photons at a lower energy and longer wavelength. The camera then captures the emitted photons [15,20] . ICG angiography used in this case was performed per SPY Elite protocol with 3 mL dose of ICG solution (ICG 2.5 mg/mL in saline diluent) administered intravenously.…”

Section: Methodsmentioning

confidence: 99%

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Is indocyanine green angiography a reliable tool for the assessment of venous congestion in muscle flaps?

Halen

Abbassi

2016

Adv Mod Oncol Res

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Indocyanine green (ICG) angiography is a useful technology for assessing flap perfusion in reconstructive procedures. Flap clearance of ICG can help in assessing venous congestion. To the best of our knowledge, although a few reports have evaluated its use for venous congestion, no reports have assessed the viability and applicability of this technology for this purpose in muscle flaps. A 63-year-old female patient with right leg leiomyosarcoma post-tumor resection underwent reconstructive surgery with a hemi-gastrocnemius flap. A scan of the flap using ICG angiography showed slow clearance of dye in the flap compared to the rest of the body. On postoperative day (POD) 1, the flap was re-examined using an infrared camera and it showed evidence of retained dye. On the contrary, there were no clinical signs of flap congestion. Ultimately, the patient had a successful reconstruction and an uncomplicated postoperative course despite the inconsistent findings in ICG angiography. ICG angiography is a useful tool in assessing arterial perfusion of flaps. However, further evaluation is needed to gain clinical reliability and validity in the evaluation of venous congestion in muscle flaps. Its overall utility with respect to pedicled muscle flaps has yet to be established.

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Section: Methodsmentioning

confidence: 99%

“…Venous congestion can also be assessed using ICG angiography by measuring the rate of dye clearance from the flap [20] . However, few studies have evaluated the appropriate technique, cut-offs, sensitivity and reliability of this method [21,22] .…”

Section: Introductionmentioning

confidence: 99%

Is indocyanine green angiography a reliable tool for the assessment of venous congestion in muscle flaps?

Halen

Abbassi

2016

Adv Mod Oncol Res

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“…56,86,98,99 Both SPY ® and SPY Elite ® generate quantitative perfusion values based on fluorescence intensity detected in the tissue. [99][100][101] This system has been investigated for multiple intraoperative uses during breast reconstruction, including perfusion assessment of mastectomy skin flaps, Open Access Surgery 2014:7 submit your manuscript | www.dovepress.com Dovepress Dovepress 6 Ferzoco pedicle flaps, and free-tissue transfers, 56,98,99,[101][102][103] and in head and neck 104 and abdominal wall reconstruction surgeries. 100 The clinical utility of the SPY ® system in breast surgery has been described by Newman and Samson, 102 who reported that perfusion problems identified with SPY ® in four of eight patients undergoing free-flap breast reconstruction led to interventions that prevented flap necrosis in three patients.…”

Section: Spy ® /Spy Elite ®mentioning

confidence: 99%

“…SPY ® technology has also been shown to be useful for aiding flap perfusion assessment in patients undergoing head and neck surgery. 104,106 Chatterjee et al 107 conducted a cost-effectiveness analysis of laser-assisted ICG angiography with SPY ® technology in immediate breast reconstruction patients who underwent mastectomy followed by autologous free-flap surgery at a single institution. In this study, the mean incremental cost-utility ratio (representing the added cost to prolong a patient's life by 1 year of perfect health) was calculated for patient groups who underwent laser-assisted ICG angiography versus those who did not.…”

Section: Spy ® /Spy Elite ®mentioning

confidence: 99%

Available and emerging technologies for assessing intraoperative tissue perfusion during complex ventral hernia repair procedures

Ferzoco¹

2013

OAS

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Abdominal wall reconstructions, and complex ventral hernia repairs in particular, pose significant challenges to surgeons and are associated with serious postoperative wound healing complications often related to poor tissue perfusion. Maintenance of adequate perfusion of central adipocutaneous tissue is critical for minimizing risk of wound-related complications following herniorrhaphy; however, accurate tissue perfusion assessment can be challenging in this setting. Technologies such as thermography and laser Doppler flowmetry are not widely used in clinical settings to assess tissue perfusion, and most surgeons currently rely upon subjective assessments of tissue viability to guide intraoperative decisions regarding reconstruction. New technological developments, including spectroscopic imaging and indocyanine green-based near-infrared laser fluorescence, permit quantitative, real-time, intraoperative visualization of tissue perfusion and have demonstrated sensitivity and accuracy in a variety of reconstructive settings. Evidence suggests these technologies can be used to optimize perfusion at the time of operation and prevent perfusion-related complications such as flap necrosis. Future studies and physician reports describing these perfusion assessment technologies in complex ventral hernia repair will supply important information regarding their utility in patients undergoing this procedure.

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“…Recent advances in nearinfrared imaging technology have made it possible to assess perfusion in a quantitative manner. The LUNA fl uorescence angiography system employs an indocyanine green (ICG) dye to allow for intraoperative and post-operative visualization of perfusion [8]. Several groups have shown that perfusion assessments utilizing LUNA fl uorescence angiography are reliable and accurate [9,10].…”

mentioning

confidence: 99%

Effects of Neoadjuvant Chemotherapy and Radiotherapy on Flap Perfusion in a Novel Mouse Model Using Standard Clinical Assessment and Near-Infrared Fluorescence Angiography

Ramesh¹,

Moore²,

Patel³

et al. 2017

Arch Otolaryngol Rhinold

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IntoductionThe clinical management of locally advanced cancers of the head and neck pose a signifi cant therapeutic challenge [1]. Despite advances in the fi eld, including the routine use of microvascular free tissue transfers in the reconstruction of defects, fl ap failure persists as a troublesome complication 2 . The underlying factors that infl uence the development of fl ap failure are varied and complex, including comorbid systemic diseases, positive surgical margins, lymph node metastases, and prior radiotherapy and/or chemotherapy [1][2][3].Radiation and chemotherapy are often administered neoadjuvantly, or prior to surgical intervention, to gauge Abstract Purpose: Minimizing surgical morbidity after local fl ap reconstruction is important in the management of cutaneous defects. Controversy exists in current literature regarding the effects of radiation and chemotherapy on fl ap perfusion. Neoadjuvant treatments can damage the microvasculature of the surgical bed through fi brosis, endothelial cell damage, and reduced cell proliferation, which collectively increase the likelihood of postoperative fl ap failure. The aim of this study is to examine the effects of neoadjuvant radiation and chemotherapy on skin fl ap perfusion.Methods: Animals were divided into three groups: control (no treatment, n=4), radiation group (36-Gy administered to dorsal skin, n=4), and chemotherapy group (2 mg/kg IP cisplatin, n=4). Treatments were performed 15 days prior to random-pattern dorsal fl ap surgery, with a fl ap length-to-width ratio of 4:1 (4x1cm2). Flap perfusion was assessed via laser-assisted (Luna, Novadaq) indocyanine green dye angiography and standard clinical assessment. Results:Fluorescence imaging was used to quantify fl ap perfusion as a fraction of healthy skin perfusion. Chemotherapy group fl aps had poorer distal end perfusion than radiation or control group fl aps (56% vs. 69% and 71%, respectively) on post-operative day (POD) 1. Clinical assessment of fl ap perfusion by experienced surgeons on POD2 found chemotherapy group fl aps to be least viable. By POD5, 100% of chemotherapy group fl aps had experienced complete fl ap loss as measured by clinical evaluation and perfusion imaging. Conclusion:Flaps receiving neoadjuvant chemotherapy performed worse than those receiving local radiotherapy or no treatment. We demonstrate the detrimental effect of neoadjuvant chemotherapy on fl ap viability in this preclinical murine model.

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Use of Intraoperative Fluorescent Angiography to Assess and Optimize Free Tissue Transfer in Head and Neck Reconstruction

Cited by 38 publications

References 26 publications

Is indocyanine green angiography a reliable tool for the assessment of venous congestion in muscle flaps?

Is indocyanine green angiography a reliable tool for the assessment of venous congestion in muscle flaps?

Available and emerging technologies for assessing intraoperative tissue perfusion during complex ventral hernia repair procedures

Effects of Neoadjuvant Chemotherapy and Radiotherapy on Flap Perfusion in a Novel Mouse Model Using Standard Clinical Assessment and Near-Infrared Fluorescence Angiography

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