Tags

Type your tag names separated by a space and hit enter

Vascularized osseous flaps and assessing their bipartate perfusion pattern via intraoperative fluorescence angiography.
J Reconstr Microsurg. 2015 Jan; 31(1):45-53.JR

Abstract

BACKGROUND

Large segmental bone and composite tissue defects often require vascularized osseous flaps for definitive reconstruction. However, failed osseous flaps due to inadequate perfusion can lead to significant morbidity. Utilization of indocyanine green (ICG) fluorescence angiography has been previously shown to reliably assess soft tissue perfusion. Our group will outline the application of this useful intraoperative tool in evaluating the perfusion of vascularized osseous flaps.

METHODS

A retrospective review was performed to identify those osseous and/or osteocutaneous bone flaps, where ICG angiography was employed. Data analyzed included flap types, success and failure rates, and perfusion-related complications. All osseous flaps were evaluated by ICG angiography to confirm periosteal and endosteal perfusion.

RESULTS

Overall 16 osseous free flaps utilizing intraoperative ICG angiography to assess vascularized osseous constructs were performed over a 3-year period. The flaps consisted of the following: nine osteocutaneous fibulas, two osseous-only fibulas, two scapular/parascapular with scapula bone, two quadricep-based muscle flaps, containing a vascularized femoral bone component, and one osteocutaneous fibula revision. All flap reconstructions were successful with the only perfusion-related complication being a case of delayed partial skin flap loss.

CONCLUSIONS

Intraoperative fluorescence angiography is a useful adjunctive tool that can aid in flap design through angiosome mapping and can also assess flap perfusion, vascular pedicle flow, tissue perfusion before flap harvest, and flap perfusion after flap inset. Our group has successfully extended the application of this intraoperative tool to assess vascularized osseous flaps in an effort to reduce adverse outcomes related to preventable perfusion-related complications.

Authors+Show Affiliations

Department of Plastic and Reconstructive Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland.Department of Plastic and Reconstructive Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland.Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.Department of Plastic and Reconstructive Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland.Department of Plastic and Reconstructive Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland.Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25469765

Citation

Valerio, Ian, et al. "Vascularized Osseous Flaps and Assessing Their Bipartate Perfusion Pattern Via Intraoperative Fluorescence Angiography." Journal of Reconstructive Microsurgery, vol. 31, no. 1, 2015, pp. 45-53.
Valerio I, Green JM, Sacks JM, et al. Vascularized osseous flaps and assessing their bipartate perfusion pattern via intraoperative fluorescence angiography. J Reconstr Microsurg. 2015;31(1):45-53.
Valerio, I., Green, J. M., Sacks, J. M., Thomas, S., Sabino, J., & Acarturk, T. O. (2015). Vascularized osseous flaps and assessing their bipartate perfusion pattern via intraoperative fluorescence angiography. Journal of Reconstructive Microsurgery, 31(1), 45-53. https://doi.org/10.1055/s-0034-1383821
Valerio I, et al. Vascularized Osseous Flaps and Assessing Their Bipartate Perfusion Pattern Via Intraoperative Fluorescence Angiography. J Reconstr Microsurg. 2015;31(1):45-53. PubMed PMID: 25469765.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Vascularized osseous flaps and assessing their bipartate perfusion pattern via intraoperative fluorescence angiography. AU - Valerio,Ian, AU - Green,J Marshall,3rd AU - Sacks,Justin M, AU - Thomas,Shane, AU - Sabino,Jennifer, AU - Acarturk,T Oguz, Y1 - 2014/12/03/ PY - 2014/12/4/entrez PY - 2014/12/4/pubmed PY - 2015/9/30/medline SP - 45 EP - 53 JF - Journal of reconstructive microsurgery JO - J Reconstr Microsurg VL - 31 IS - 1 N2 - BACKGROUND: Large segmental bone and composite tissue defects often require vascularized osseous flaps for definitive reconstruction. However, failed osseous flaps due to inadequate perfusion can lead to significant morbidity. Utilization of indocyanine green (ICG) fluorescence angiography has been previously shown to reliably assess soft tissue perfusion. Our group will outline the application of this useful intraoperative tool in evaluating the perfusion of vascularized osseous flaps. METHODS: A retrospective review was performed to identify those osseous and/or osteocutaneous bone flaps, where ICG angiography was employed. Data analyzed included flap types, success and failure rates, and perfusion-related complications. All osseous flaps were evaluated by ICG angiography to confirm periosteal and endosteal perfusion. RESULTS: Overall 16 osseous free flaps utilizing intraoperative ICG angiography to assess vascularized osseous constructs were performed over a 3-year period. The flaps consisted of the following: nine osteocutaneous fibulas, two osseous-only fibulas, two scapular/parascapular with scapula bone, two quadricep-based muscle flaps, containing a vascularized femoral bone component, and one osteocutaneous fibula revision. All flap reconstructions were successful with the only perfusion-related complication being a case of delayed partial skin flap loss. CONCLUSIONS: Intraoperative fluorescence angiography is a useful adjunctive tool that can aid in flap design through angiosome mapping and can also assess flap perfusion, vascular pedicle flow, tissue perfusion before flap harvest, and flap perfusion after flap inset. Our group has successfully extended the application of this intraoperative tool to assess vascularized osseous flaps in an effort to reduce adverse outcomes related to preventable perfusion-related complications. SN - 1098-8947 UR - https://www.unboundmedicine.com/medline/citation/25469765/Vascularized_osseous_flaps_and_assessing_their_bipartate_perfusion_pattern_via_intraoperative_fluorescence_angiography_ L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-0034-1383821 DB - PRIME DP - Unbound Medicine ER -