Use of Intraoperative Fluorescent Indocyanine Green Angiography for Real-Time Vascular Evaluation of Pericranial Flaps

Yano, Tomoyuki; Okazaki, Mutsumi; Tanaka, Kentaro; Tsunoda, Atsunobu; Aoyagi, Masaru; Kishimoto, Seiji

doi:10.1097/sap.0000000000000519

Cited by 13 publications

(17 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Forty-nine articles, including 1996 surgical flaps, were selected for the review. Study designs included prospective cohort studies (n = 27), 31,34,35,38,39,[41][42][43][47][48][49][50]56,[58][59][60][62][63][64][65][66][67][68][69][70][71] retrospective cohort studies (n = 16), [25][26][27]29,32,33,36,40,44,45,51,55,57,61,72 prospective pilot studies (n = 3), 28,37,52 and retrospective case series (n = 3). 46,53,54 No randomized controlled trials have been performed yet that concern ICGA in plastic and reconstructive flap surgery.…”

Section: Systematic Reviewmentioning

confidence: 99%

“…Indocyanine green angiography has been reported for several types of flaps in plastic and reconstructive flap surgery in a clinical setting. The majority of included articles used ICGA to assess tissue perfusion of mastectomy skin flap (n = 14) intraoperatively 25,26,[31][32][33][39][40][41]47,51,55,57,58,61 ; the remainder focused on the intraoperative assessment of nipple-areolar complex perfusion, 27,72 a combination of nipple-areolar complex and mastectomy skin flap perfusion, 24 anterolateral thigh flap, 28,29 deep inferior epigastric perforator flap, 38,56,66 transverse rectus abdominis myocutaneous flap, 38,56,70 superficial inferior epigastric artery flap, 64,65,73 superficial circrumflex iliac artery flap, 50 free pericranial flap, 36 latissimus dorsi flap, 34 free parascapular flaps, 63 paramedian forehead flap, 43 intercostal muscle flap, 52 osseus free flaps, 44 free fibula flap, 45 and various pedicled and/or free flaps. 30,35,37,42,46,48,53,54,59,…”

Section: Systematic Reviewmentioning

confidence: 99%

“…Several ICGA systems have been described in the literature. In the majority of included studies (n = 29), 24,[26][27][28][30][31][32][38][39][40][41][43][44][45][46][47]51,[53][54][55][56][57][58][59][60][61][62]72,73 the SPY imaging system (Novadaq Technologies, Inc, Toronto, Canada) was used for tissue perfusion assessment; the remainder used the IC-View System (Pulsion Medical Systems, Munich, Germany; n = 8), [63][64][65][66][67][68][69][70] the Photo Dynamic Eye (Hamamatsu Photonics KK, Hamamatsu, Japan; n = 7), 29,33,35,36,48,50,52 the Visionsense 3D highdefinition near-infrared-guided indocyanine green video angiography system (ICG-NIR-VA, Orangeburg, NY; n = 1), 42 Hyper Eye Medical System (Mizuho Medical Co, Ltd, Tokyo, Japan; n = 1), 34 the Fluobeam device (Fl...…”

Section: Systematic Reviewmentioning

confidence: 99%

See 2 more Smart Citations

Optimizing Indocyanine Green Fluorescence Angiography in Reconstructive Flap Surgery: A Systematic Review and Ex Vivo Experiments

et al. 2019

View full text Add to dashboard Cite

Background. Indocyanine green angiography (ICGA) offers the potential to provide objective data for evaluating tissue perfusion of flaps and reduce the incidence of postoperative necrosis. Consensus on ICGA protocols and information on factors that have an influence on fluorescence intensity is lacking. The aim of this article is to provide a comprehensive insight of in vivo and ex vivo evaluation of factors influencing the fluorescence intensity when using ICGA during reconstructive flap surgery. Methods. A systematic literature search was conducted to provide a comprehensive overview of currently used ICGA protocols in reconstructive flap surgery. Additionally, ex vivo experiments were performed to further investigate the practical influence of potentially relevant factors. Results. Factors that are considered important in ICGA protocols, as well as factors that might influence fluorescence intensity are scarcely reported. The ex vivo experiments demonstrated that fluorescence intensity was significantly related to dose, working distance, angle, penetration depth, and ambient light. Conclusions. This study identified factors that significantly influence the fluorescence intensity of ICGA. Applying a weight-adjusted ICG dose seems preferable over a fixed dose, recommended working distances are advocated, and the imaging head during ICGA should be positioned in an angle of 60° to 90° without significantly influencing the fluorescence intensity. All of these factors should be considered and reported when using ICGA for tissue perfusion assessment during reconstructive flap surgery.

show abstract

Section: Systematic Reviewmentioning

confidence: 99%

Section: Systematic Reviewmentioning

confidence: 99%

Section: Systematic Reviewmentioning

confidence: 99%

See 1 more Smart Citation

Optimizing Indocyanine Green Fluorescence Angiography in Reconstructive Flap Surgery: A Systematic Review and Ex Vivo Experiments

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Additionally, vascularization of anteriorly based PCF was found to be superior to laterally based flaps in a recent experimental study, suggesting a more reliable and durable reconstruction. 11 An extracranial PCF minimizes the morbidity of PCF reconstruction by avoiding a craniotomy. There is also potential for minimally invasive endoscopic harvest.…”

Section: Discussionmentioning

confidence: 99%

Clinical Experience with Secondary Endoscopic Reconstruction of Clival Defects with Extracranial Pericranial Flaps

et al. 2018

View full text Add to dashboard Cite

Objectives The aim of this study is to report the clinical outcome of extracranial pericranial flaps (ePCF) used for reconstruction of clival dural defects following failure of primary repair. Design Retrospective review of skull base database. Setting Academic medical center. Participants Patients undergoing reconstruction of clival defects with ePCF following endoscopic endonasal surgery (EES). Main outcome measures Postoperative cerebrospinal fluid (CSF) leak, meningitis, and flap necrosis. Results Seven patients (five males and two females) who underwent ePCF reconstruction for clival defects following EES were included. All patients (ages 8–64 years) had a postoperative CSF leak due to a failed primary clival reconstruction (five had one, one had two, and one had three failed CSF leak repairs prior to ePCF reconstruction). Nasoseptal and inferior turbinate (lateral nasal wall) flaps were not available for secondary reconstruction due to prior surgeries. The immediate success rate of ePCF for the reconstruction of clival defects in patients with multiple flap failures was 58%. Two patients developed CSF leaks that were successfully repaired endoscopically with the addition of free tissue grafts; one patient had partial flap necrosis that required debridement; none required an additional vascularized flap. Width of the defect, length of the defect, properties of the ePCF, and age did not demonstrate significance (p > 0.05) for adverse outcome. Conclusion An ePCF is a reconstructive option for high-risk, large clival defects when other local and regional vascularized flaps are not available or fail. ePCFs can be used for reconstruction of clival defects in all populations, including pediatric patients.

show abstract

“…ICGA is widely used due to its technical simplicity and low risk of complications. 6 In the field of plastic surgery, ICGA is used in various procedures including the evaluation of elevated flaps, 7–10 identification of perforator vessels, 11–13 and assessment of blood perfusion to nerves. 14 Previous studies reported that rates of postoperative flap necrosis were improved by intraoperative ICGA-guided trimming.…”

Section: Introductionmentioning

confidence: 99%

Prediction of Skin Necrosis after Mastectomy for Breast Cancer Using Indocyanine Green Angiography Imaging

Gorai¹,

Inoue

Saegusa

et al. 2017

Plastic and Reconstructive Surgery - Global Open

Self Cite

View full text Add to dashboard Cite

Background:In immediate tissue expander reconstruction following total mastectomy for breast cancer, indocyanine green angiography (ICGA)–guided skin trimming is useful for the prevention of complications. However, instances of unclear ICGA contrast can occur with this method, which are difficult to judge as to whether preventive trimming is warranted. To further improve the mastectomy flap necrosis rate, more accurate objective parameters are necessary.Methods:The degree of clinical improvement was compared between 81 patients trimmed according to the surgeon’s judgment (non-ICGA group) and 100 patients with ICGA-guided trimming (ICGA group). We then retrospectively measured 3 parameters [relative perfusion (RP); time (T) to reach RPmax; and slope (S = RP/T) reflecting the rate of increase to RPmax] by using region of interest analysis software and examined their relationships with skin necrosis.Results:The rate of grade III necrosis (reaching the subcutaneous fat layer) was significantly lower in the ICGA group (4.8%) than in the non-ICGA group (17.8%; P < 0.05). The specificity of RP for the diagnosis of skin necrosis was high (98.5%; cutoff value, 34). However, the sensitivities of slope parameters were higher than RP.Conclusions:ICGA-guided trimming decreased the rate of deep skin necrosis requiring additional surgical treatment. Region of interest analysis indicated that a relatively low percentage luminescence (RP < 34) was indicative of the need for skin trimming, combined with a slow increase in the perfusion of the mastectomy skin flaps.

show abstract

Use of Intraoperative Fluorescent Indocyanine Green Angiography for Real-Time Vascular Evaluation of Pericranial Flaps

Cited by 13 publications

References 20 publications

Optimizing Indocyanine Green Fluorescence Angiography in Reconstructive Flap Surgery: A Systematic Review and Ex Vivo Experiments

Optimizing Indocyanine Green Fluorescence Angiography in Reconstructive Flap Surgery: A Systematic Review and Ex Vivo Experiments

Clinical Experience with Secondary Endoscopic Reconstruction of Clival Defects with Extracranial Pericranial Flaps

Prediction of Skin Necrosis after Mastectomy for Breast Cancer Using Indocyanine Green Angiography Imaging

Contact Info

Product

Resources

About