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

Jon Ver Halen, Bahar Abbassi

Abstract


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.

Keywords


muscle flap; pedicled flap; free flap; indocyanine green angiography

Full Text:

PDF

References


Kubo T, Yano K, Hosokawa K. Management of flaps with compromised venous outflow in head and neck microsurgical reconstruction. Microsurgery 2002; 22(8): 391–395. doi: 10.1002/micr.10059.

Garvey PB, Buchel EW, Pockaj BA, Casey WJ III, Gray RJ, Hernández JL, Samson T. DIEP and pedicled TRAM flaps: A comparison of outcomes. Plast Reconstr Surg 2006; 117(6): 1711– 1719. doi: 10.1097/01.prs.0000210679.77449.7d.

Spear SL, Ducic I, Cuoco F, Hannan C. The effect of smoking on flap and donor-site complications in pedicled TRAM breast reconstruction. Plast Reconstr Surg 2005; 116(7): 1873–1880. doi: 10.1097/01.prs.0000191200. 81375.8c.

Tsai TM, Bennett DL, Pederson WC, Matiko J. Complications and vascular salvage of free-tissue transfers to the extremities. Plast Reconstr Surg 1988; 82(6): 1022–1026. doi: 10.1097/01.prs.00006534-198812000-00013.

Wheatley MJ, Meltzer TR. The role of vascular pedicle thrombectomy in the management of compromised free tissue transfers. Ann Plast Surg 1996; 36(4): 360–364. doi: 10.1097/00000637-199604000-00006.

Yajima H, Tamai S, Mizumoto S, Ono H, Fukui A. Vascular complications of vascularized composite tissue transfer: outcome and salvage techniques. Microsurgery 1993; 14: 473–478. doi: 10.1002/micr.1920140802

Pestana IA, Coan B, Erdmann D, Marcus J, Levin LS, Zenn MR. Early experience with fluorescent angiography in free-tissue transfer reconstruction. Plast Reconstr Surg 2009; 123(4): 1239–1244. doi: 10.1097/PRS.0b013e318-19e67c1.

Newman MI, Samson MC, Tamburrino JF, Swartz KA, Brunworth L. An investigation of the application of laser-assisted indocyanine green fluorescent dye angiography in pedicle transverse rectus abdominus myocutaneous breast reconstruction. Can J Plast Surg 2011; 19(1): e1–e5.

Jallali N, Ridha H, Butler PE. Postoperative monitoring of free flaps in UK plastic surgery units. Microsurgery 2005; 25(6): 469–472. doi: 10.1002/micr.20148.

Mothes H, Dönicke T, Friedel R, Simon M, Markgraf E, Bach O. Indocyanine-green fluorescence video angiography used clinically to evaluate tissue perfusion in microsurgery. J Trauma 2004; 57(5): 1018–1024. doi: 10.1097/01.TA.0000123041.47008.70.

Olivier WA, Hazen A, Levine JP, Soltanian H, Chung S, Gurtner GC. Reliable assessment of skin flap viability using orthogonal polarization imaging. Plast Reconstr Surg 2003; 112(2): 547–555. doi: 10.1097/01.PRS.0000070968.42857.43.

Tan BK, Newman MI, Swartz KA, Samson MC. Subfascial perforator dissection for DIEP flap harvest. Plast Reconstr Surg 2009; 124(3): 1001–1002. doi: 10.1097/PRS.0b013e3181b03953.

Newman MI, Samson MC. The application of laser-assisted indocyanine green fluorescent dye angiography in microsurgical breast reconstruction. J Reconstr Microsurg 2009; 25(1): 21–26. doi: 10.1055/s-0028-1090617.

Phillips BT, Lanier ST, Conkling N, Wang ED, Dagum AB, Ganz JC, Khan SU, Bui DT. Intraoperative perfusion techniques can accurately predict mastectomy skin flap necrosis in breast re-construction: results of a prospective trial. Plast Reconstr Surg 2012; 129(5): 778e–788e. doi: 10.1097/PRS.0b13 e31824a2ae8.

Giunta RE, Holzbach T, Taskov C, Holm PS, Brill T, Busch R, Gansbacher B, Biemer E. Prediction of flap necrosis with laser induced indocyanine green fluorescence in a rat model. Br J Plast Surg 2005; 58(5): 695–701. doi: 10.1016/j.bjps.2005.02.018.

Holm C, Mayr M, Höfter E, Becker A, Pfeiffer UJ, Mühlbauer W. Intraoperative evaluation of skin-flap viability using laser-induced fluorescence of indocyanine green. Br J Plast Surg 2002; 55(8): 635–644. doi: 10.1054/bjps.2002.3969.

Still J, Law E, Dawson J, Bracci S, Island T, Holtz J. Evaluation of the circulation of reconstructive flaps using laser-induced fluorescence of indocyanine green. Ann Plast Surg 1999; 42(3): 266–274. doi: 10.1097/00000637-199903000-00007.

Komorowska-Timek E, Gurtner GC. Intraoperative perfusion mapping with laser-assisted indocyanine green imaging can predict and prevent complications in immediate breast reconstruction. Plast Reconstr Surg 2010; 125(4): 1065–1073. doi: 10.1097/PRS.0b013e3181d17f80.

Elite System SPY. Kit instructions for use. Branchburg, NJ: LifeCell Corp; 2011.

Green JM III, Thomas S, Sabino J, Howard R, Basile P, Dryden S, Crecelius C, Valerio I. Use of intraoperative fluorescent angiography to assess and optimize free tissue transfer in head and neck reconstruction. J Oral Maxillofac Surg 2013; 71(8): 1439–1449. doi: 10.1016/j.joms.2013.01.019.

Krishnan KG, Schackert G, Steinmeier R. The role of near-infrared angiography in the assessment of post-operative venous congestion in random pattern, pedicled island and free flaps. Br J Plast Surg 2005; 58(3): 330–338. doi: 10.1016/j.bjps.2004.10.003.

Wu C, Kim S, Halvorson EG. Laser-assisted indocyanine green angiography: A critical appraisal. Ann Plast Surg 2013; 70(5): 613–619. doi: 10.1097/SAP.0b013e31827565f3.




DOI: http://dx.doi.org/10.30564/amor.v2i1.29

Refbacks

  • There are currently no refbacks.


Copyright (c) 2018 Jon Ver Halen, Bahar Abbassi

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.