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Assessment of the patency of microvascular anastomoses using microscope-integrated near-infrared angiography: a preliminary study.
Microsurgery. 2009; 29(7):509-14.M

Abstract

BACKGROUND

: Technical problems at the site of the anastomosis compromise an underappreciated proportion of microsurgical free tissue transfers. Intraoperative identification of technical errors may be able to prevent reexploration surgery and early flap failure. We report the first human study on a new microscope-integrated fluorescence angiography technique, which allows for intraoperative imaging of the anastomotic site.

METHODS

: Fifty consecutive patients undergoing reconstructive microsurgical procedures were enrolled in the study. Intraoperative near infrared indocyanine green videoangiography (ICGA) was performed on all microsurgical anastomoses, after they had been assessed by the operating surgeon by conventional clinical patency tests. Anastomoses deemed to be occluded by the ICG-angiography were intraoperatively revised, and the result of revision was compared with angiographic findings.

RESULTS

: In 11/50 (22%) of patients, where the surgeon had classified the anastomoses as patent, microangiography identified a total luminal occlusion (six) and/or significant alterations in blood flow (five), potentially predisposing toward postoperative flap failure. Intraoperative revision confirmed angiographic findings in 100% of cases, and was always associated with flap survival. The decision not to revise despite anastomotic occlusion by the intraoperative angiogram was always followed by flap loss or early reexploration. A delayed return of venous blood from the flap predisposed toward postoperative flap failure.

CONCLUSIONS

: Hand-sewn anastomoses are subject to technical errors, and conventional patency tests have a low sensitivity for revealing anastomotic failure. Microscope integrated microangiography is an excellent method for identifying significant anastomotic problems, which would have otherwise gone unnoticed. The potential impact on early flap failure and reexploration surgery is considerable. (c) 2009 Wiley-Liss, Inc. Microsurgery 2009.

Authors+Show Affiliations

Department of Plastic, Reconstructive and Hand Surgery, Burn Centre, Klinikum Bogenhausen, Technical University Munich, Englschalkingerstrasse 77, Munich 81925, Germany. charlotte_holmjakobsen@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19306390

Citation

Holm, Charlotte, et al. "Assessment of the Patency of Microvascular Anastomoses Using Microscope-integrated Near-infrared Angiography: a Preliminary Study." Microsurgery, vol. 29, no. 7, 2009, pp. 509-14.
Holm C, Mayr M, Höfter E, et al. Assessment of the patency of microvascular anastomoses using microscope-integrated near-infrared angiography: a preliminary study. Microsurgery. 2009;29(7):509-14.
Holm, C., Mayr, M., Höfter, E., Dornseifer, U., & Ninkovic, M. (2009). Assessment of the patency of microvascular anastomoses using microscope-integrated near-infrared angiography: a preliminary study. Microsurgery, 29(7), 509-14. https://doi.org/10.1002/micr.20645
Holm C, et al. Assessment of the Patency of Microvascular Anastomoses Using Microscope-integrated Near-infrared Angiography: a Preliminary Study. Microsurgery. 2009;29(7):509-14. PubMed PMID: 19306390.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Assessment of the patency of microvascular anastomoses using microscope-integrated near-infrared angiography: a preliminary study. AU - Holm,Charlotte, AU - Mayr,Martina, AU - Höfter,Eugen, AU - Dornseifer,Ulf, AU - Ninkovic,Milomir, PY - 2009/3/24/entrez PY - 2009/3/24/pubmed PY - 2010/1/8/medline SP - 509 EP - 14 JF - Microsurgery JO - Microsurgery VL - 29 IS - 7 N2 - BACKGROUND: : Technical problems at the site of the anastomosis compromise an underappreciated proportion of microsurgical free tissue transfers. Intraoperative identification of technical errors may be able to prevent reexploration surgery and early flap failure. We report the first human study on a new microscope-integrated fluorescence angiography technique, which allows for intraoperative imaging of the anastomotic site. METHODS: : Fifty consecutive patients undergoing reconstructive microsurgical procedures were enrolled in the study. Intraoperative near infrared indocyanine green videoangiography (ICGA) was performed on all microsurgical anastomoses, after they had been assessed by the operating surgeon by conventional clinical patency tests. Anastomoses deemed to be occluded by the ICG-angiography were intraoperatively revised, and the result of revision was compared with angiographic findings. RESULTS: : In 11/50 (22%) of patients, where the surgeon had classified the anastomoses as patent, microangiography identified a total luminal occlusion (six) and/or significant alterations in blood flow (five), potentially predisposing toward postoperative flap failure. Intraoperative revision confirmed angiographic findings in 100% of cases, and was always associated with flap survival. The decision not to revise despite anastomotic occlusion by the intraoperative angiogram was always followed by flap loss or early reexploration. A delayed return of venous blood from the flap predisposed toward postoperative flap failure. CONCLUSIONS: : Hand-sewn anastomoses are subject to technical errors, and conventional patency tests have a low sensitivity for revealing anastomotic failure. Microscope integrated microangiography is an excellent method for identifying significant anastomotic problems, which would have otherwise gone unnoticed. The potential impact on early flap failure and reexploration surgery is considerable. (c) 2009 Wiley-Liss, Inc. Microsurgery 2009. SN - 1098-2752 UR - https://www.unboundmedicine.com/medline/citation/19306390/Assessment_of_the_patency_of_microvascular_anastomoses_using_microscope_integrated_near_infrared_angiography:_a_preliminary_study_ L2 - https://doi.org/10.1002/micr.20645 DB - PRIME DP - Unbound Medicine ER -