Endoscopic assessment of free flap perfusion in the upper aerodigestive tract using indocyanine green
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Endoscopic assessment of free flap perfusion in the upper aerodigestive tract using indocyanine green : a pilot study. / Betz, Christian Stephan; Zhorzel, Sven; Schachenmayr, Hilmar; Stepp, Herbert; Matthias, Christoph; Hopper, Colin; Harréus, Ulrich.
In: J PLAST RECONSTR AES, Vol. 66, No. 5, 05.2013, p. 667-74.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Endoscopic assessment of free flap perfusion in the upper aerodigestive tract using indocyanine green
T2 - a pilot study
AU - Betz, Christian Stephan
AU - Zhorzel, Sven
AU - Schachenmayr, Hilmar
AU - Stepp, Herbert
AU - Matthias, Christoph
AU - Hopper, Colin
AU - Harréus, Ulrich
N1 - Copyright © 2013. Published by Elsevier Ltd.
PY - 2013/5
Y1 - 2013/5
N2 - 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.
AB - 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.
KW - Aged
KW - Anastomosis, Surgical
KW - Coloring Agents
KW - Endoscopy
KW - Female
KW - Free Tissue Flaps
KW - Head and Neck Neoplasms
KW - Humans
KW - Indocyanine Green
KW - Male
KW - Microsurgery
KW - Middle Aged
KW - Pilot Projects
KW - Prospective Studies
KW - Reconstructive Surgical Procedures
KW - Comparative Study
KW - Journal Article
KW - Research Support, Non-U.S. Gov't
U2 - 10.1016/j.bjps.2012.12.034
DO - 10.1016/j.bjps.2012.12.034
M3 - SCORING: Journal article
C2 - 23391541
VL - 66
SP - 667
EP - 674
JO - J PLAST RECONSTR AES
JF - J PLAST RECONSTR AES
SN - 1748-6815
IS - 5
ER -
