Endoscopic measurements of free-flap perfusion in the head and neck region using red-excited Indocyanine Green: preliminary results

Betz, C.S.; Zhorzel, S.; Schachenmayr, H.; Stepp, H.; Havel, M.; Siedek, V.; Leunig, A.; Matthias, C.; Hopper, C.; Harreus, U.

doi:10.1016/j.bjps.2008.07.042

« Previous Next »Journal of Plastic, Reconstructive & Aesthetic Surgery
Volume 62, Issue 12 , Pages 1602-1608, December 2009

Endoscopic measurements of free-flap perfusion in the head and neck region using red-excited Indocyanine Green: preliminary results☆

C.S. Betz
- Department of Otorhinolaryngology, Head & Neck Surgery, Ludwig Maximilian University, Großhadern Medical Campus, Marchioninistr. 15, D-81377 Munich, Germany
- Corresponding author. Department of Otorhinolaryngology, Ludwig Maximilian University Munich, Großhadern Medical Campus, Marchioninistr. 15, 81377 Munich, Germany. Tel.: +49 89 7095 0; fax: +49 89 7095 4864.
S. Zhorzel
- Department of Otorhinolaryngology, Head & Neck Surgery, Ludwig Maximilian University, Großhadern Medical Campus, Marchioninistr. 15, D-81377 Munich, Germany
H. Schachenmayr
- Laser-Research Laboratory, LIFE Center, Ludwig Maximilian University, Großhadern Medical Campus, Marchioninistr. 23, D-81377 Munich, Germany
H. Stepp
- Laser-Research Laboratory, LIFE Center, Ludwig Maximilian University, Großhadern Medical Campus, Marchioninistr. 23, D-81377 Munich, Germany
M. Havel
- Department of Otorhinolaryngology, Head & Neck Surgery, Ludwig Maximilian University, Großhadern Medical Campus, Marchioninistr. 15, D-81377 Munich, Germany
V. Siedek
- Department of Otorhinolaryngology, Head & Neck Surgery, Ludwig Maximilian University, Großhadern Medical Campus, Marchioninistr. 15, D-81377 Munich, Germany
A. Leunig
- Department of Otorhinolaryngology, Head & Neck Surgery, Ludwig Maximilian University, Großhadern Medical Campus, Marchioninistr. 15, D-81377 Munich, Germany
C. Matthias
- Department of Otorhinolaryngology, University of Goettingen, Robert-Koch-Str. 40, D-37075 Goettingen, Germany
C. Hopper
- Department of Oral and Maxillofacial Surgery, University College London Hospital, Mortimer Market, London WC1E 6AU, UK
U. Harreus
- Department of Otorhinolaryngology, Head & Neck Surgery, Ludwig Maximilian University, Großhadern Medical Campus, Marchioninistr. 15, D-81377 Munich, Germany

Received 2 May 2008; accepted 24 July 2008. published online 26 November 2008.

Summary

Background

Free-tissue transfer has become a standard procedure for reconstructive surgery in the head and neck area. Flap failures are relatively rare (≤5%), and a high percentage can be salvaged if detected early. Indocyanine Green (ICG) angiography might be able to improve the detection of flap malperfusion at an early stage.

Methods

So far, 11 patients with free-flap reconstructions of the upper aerodigestive tract (UADT) have participated in this study. Each participant underwent three endoscopic ICG angiographies (24h intra-operatively and 72h postoperatively). The data obtained were evaluated online as well as offline on a personal computer (PC), and the results compared to the clinical outcome.

Results

There were no partial or complete flap losses. One flap was successfully salvaged following initial arterial kinking with impeded perfusion. The ICG fluorescence angiography was tolerated well in all patients. The free flaps showed a delayed yet equal ICG fluorescence as compared to the surrounding tissue. The timing and slope of fluorescence build-up were dependent on circulatory factors. The relative fluorescence maxima of flap versus surrounding were 33% in the initially failing flap and ≥64% for all other examinations.

Conclusions

It was possible to prove the feasibility of endoscopic ICG fluorescence angiography in patients undergoing free-flap transfer to the UADT. The method provides instant information about the perfusion state of the tissue and is easily performed without greater patient discomfort or risk of side effects. Due to the endoscopic approach, the method seems highly promising for this indication and merits further evaluation.

Keywords: Free flap, Fluorescence angiography, Indocyanine Green, Perfusion