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Use of intraoperative fluorescent angiography to assess and optimize free tissue transfer in head and neck reconstruction.
J Oral Maxillofac Surg 2013; 71(8):1439-49JO

Abstract

PURPOSE

Composite tissue defects in the head and neck region present unique challenges. Definitive head and neck reconstruction of these cases is often complicated by complex 3-dimensional defects that may require multiple flap or chimeric flap procedures. These advanced techniques can have serious repercussions should poor perfusion of the flap cause flap failure, which can be devastating.

MATERIALS AND METHODS

A retrospective review was completed for those complex reconstructions using free tissue transfers and fluorescent indocyanine green angiography (Lifecell SPY Elite imaging, Lifecell Corporation, Bridgewater, NJ) at Walter Reed National Military Medical Center over a 24-month period. Data analyzed included flap type (myocutaneous, osteocutaneous, or fasciocutaneous), flap success and failure rates, and complications. These also were compared with data from the institution before the study period and the incorporation of SPY technology.

RESULTS

Sixty-one free flaps, including 11 head and neck flaps, were performed. The head and neck flaps included 1 latissimus, 3 gracilis, 1 vastus lateralis, 4 anterior lateral thigh, and 2 fibular flaps. The overall success rate was 98.4%; 1 flap was lost (1.6%) and 2 flaps developed partial flap necrosis (3.3%). Where SPY Elite was used, there was no unpredicted partial flap necrosis. The only total flap loss was related to a hypercoagulable condition.

CONCLUSIONS

Free tissue transfer can be technically challenging, especially in complex head and neck reconstruction. An algorithmic approach using SPY Elite imaging aids in pedicle location, angiosomal assessment, anastomotic flow visualization, and cutaneous and osteocutaneous flap perfusion assessment. This objective tool can assist the reconstructive surgeon in avoiding perfusion-related complications and total and partial flap losses, thus improving patient outcomes.

Authors+Show Affiliations

Oral and Maxillofacial Surgery Service, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA. Marshall.Green@med.navy.milNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23541991

Citation

Green, J Marshall, et al. "Use of Intraoperative Fluorescent Angiography to Assess and Optimize Free Tissue Transfer in Head and Neck Reconstruction." Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons, vol. 71, no. 8, 2013, pp. 1439-49.
Green JM, Thomas S, Sabino J, et al. Use of intraoperative fluorescent angiography to assess and optimize free tissue transfer in head and neck reconstruction. J Oral Maxillofac Surg. 2013;71(8):1439-49.
Green, J. M., Thomas, S., Sabino, J., Howard, R., Basile, P., Dryden, S., ... Valerio, I. (2013). Use of intraoperative fluorescent angiography to assess and optimize free tissue transfer in head and neck reconstruction. Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons, 71(8), pp. 1439-49. doi:10.1016/j.joms.2013.01.019.
Green JM, et al. Use of Intraoperative Fluorescent Angiography to Assess and Optimize Free Tissue Transfer in Head and Neck Reconstruction. J Oral Maxillofac Surg. 2013;71(8):1439-49. PubMed PMID: 23541991.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Use of intraoperative fluorescent angiography to assess and optimize free tissue transfer in head and neck reconstruction. AU - Green,J Marshall,3rd AU - Thomas,Shane, AU - Sabino,Jennifer, AU - Howard,Robert, AU - Basile,Patrick, AU - Dryden,Steven, AU - Crecelius,Chris, AU - Valerio,Ian, Y1 - 2013/03/29/ PY - 2012/10/02/received PY - 2012/12/14/revised PY - 2013/01/21/accepted PY - 2013/4/2/entrez PY - 2013/4/2/pubmed PY - 2013/9/24/medline SP - 1439 EP - 49 JF - Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons JO - J. Oral Maxillofac. Surg. VL - 71 IS - 8 N2 - PURPOSE: Composite tissue defects in the head and neck region present unique challenges. Definitive head and neck reconstruction of these cases is often complicated by complex 3-dimensional defects that may require multiple flap or chimeric flap procedures. These advanced techniques can have serious repercussions should poor perfusion of the flap cause flap failure, which can be devastating. MATERIALS AND METHODS: A retrospective review was completed for those complex reconstructions using free tissue transfers and fluorescent indocyanine green angiography (Lifecell SPY Elite imaging, Lifecell Corporation, Bridgewater, NJ) at Walter Reed National Military Medical Center over a 24-month period. Data analyzed included flap type (myocutaneous, osteocutaneous, or fasciocutaneous), flap success and failure rates, and complications. These also were compared with data from the institution before the study period and the incorporation of SPY technology. RESULTS: Sixty-one free flaps, including 11 head and neck flaps, were performed. The head and neck flaps included 1 latissimus, 3 gracilis, 1 vastus lateralis, 4 anterior lateral thigh, and 2 fibular flaps. The overall success rate was 98.4%; 1 flap was lost (1.6%) and 2 flaps developed partial flap necrosis (3.3%). Where SPY Elite was used, there was no unpredicted partial flap necrosis. The only total flap loss was related to a hypercoagulable condition. CONCLUSIONS: Free tissue transfer can be technically challenging, especially in complex head and neck reconstruction. An algorithmic approach using SPY Elite imaging aids in pedicle location, angiosomal assessment, anastomotic flow visualization, and cutaneous and osteocutaneous flap perfusion assessment. This objective tool can assist the reconstructive surgeon in avoiding perfusion-related complications and total and partial flap losses, thus improving patient outcomes. SN - 1531-5053 UR - https://www.unboundmedicine.com/medline/citation/23541991/Use_of_intraoperative_fluorescent_angiography_to_assess_and_optimize_free_tissue_transfer_in_head_and_neck_reconstruction_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0278-2391(13)00103-1 DB - PRIME DP - Unbound Medicine ER -