Endoscopic assessment of free flap perfusion in the upper aerodigestive tract using indocyanine green: A?pilot study

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• 作者：Christian Stephan Betz^a ; ^{christian.betz@med.uni-muenchen.de} ; Sven Zhorzel^a ; ^b ; Hilmar Schachenmayr^c ; Herbert Stepp^c ; Christoph Matthias^d ; Colin Hopper^e ; Ulrich Harré ; us^a
• 关键词：Indocyanine green ; Free flap ; Monitoring ; Upper aerodigestive tract ; Head and neck cancer
• 刊名：Journal of Plastic, Reconstructive Aesthetic Surgery
• 出版年：2013
• 出版时间：May, 2013
• 年：2013
• 卷：66
• 期：5
• 页码：667-674
• 全文大小：823 K

文摘

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Summary

Introduction

Malfunction of microvascular anastomoses is the main reason for free-flap failures. The aim of this investigation was to prove the feasibility of endoscopic free-flap perfusion measurements in the upper aerodigestive tract (UADT) using indocyanine green (ICG).

Methods

Twenty-five patients undergoing free-flap reconstruction of the UADT were included. At least three ICG angiographies (0?h, 24?h and 72?h) were performed per participant. The sequences were subjectively judged online. The data were subsequently analysed, the results compared to clinical outcome and a survey with clinical staff (n?=?21) performed.

Results

All 25 flaps survived. The ICG angiographies were tolerated well, showing a delayed fluorescence gain in transplanted tissue compared to surrounding but comparable final maximum fluorescence intensities. Four surgical revisions (two for a true and two for a false indication) could be additionally investigated. The two flaps with a real perfusion compromise showed fluorescence Indices (relative fluorescence maxima of transplant vs. surrounding) of 33 % and 37 % , whereas these values lay above 60 % for all other examinations (including those two flaps that were revised for a false indication). The survey showed that ICG angiography leads to a better discrimination of well- and malperfused flaps compared with conventional inspection.

Conclusion

In this small level IIb study, it was possible to prove the feasibility of endoscopic ICG angiography in patients with free-tissue transfer to the UADT. In difficult situations, it seems a welcome adjunct to conventional screening and might aid in the decision whether to revise a clinically suspect flap.