Tags

Type your tag names separated by a space and hit enter

Assessment of Fibula Flap Skin Perfusion in Patients Undergoing Oromandibular Reconstruction: Comparison of Clinical Findings, Fluorescein, and Indocyanine Green Angiography.
JAMA Facial Plast Surg 2015 Nov-Dec; 17(6):422-6JF

Abstract

IMPORTANCE

Complications of partial flap necrosis contribute substantially to morbidity in patients who undergo head and neck reconstructive surgery.

OBJECTIVE

To assess the usefulness of clinical findings, intraoperative fluorescein angiography, and intraoperative indocyanine green angiography (ICGA) for evaluation of flap skin paddle perfusion in patients undergoing oromandibular reconstruction who are at high risk of partial skin paddle necrosis.

DESIGN, SETTING, AND PARTICIPANTS

Retrospective medical record review from May 21, 1996, to May 27, 2015, at a tertiary care academic medical center. Participants were 73 patients who underwent reconstruction of through-and-through defects of the mucosa, mandible, and skin using fibula free flaps that contained large bilobed skin paddles.

MAIN OUTCOMES AND MEASURES

The rates of partial skin paddle necrosis and revision reconstructive surgery.

RESULTS

The rates of partial flap necrosis were 8% (n = 2) among 25 patients in whom the skin paddle was trimmed based on ICGA and 33% (n = 16) among 48 patients in whom the skin paddle was trimmed according to clinical findings (P = .02). The rates of revision reconstructive surgery were 20% (5 of 25) when flap skin paddles were trimmed using ICGA and 42% (20 of 48) when trimmed per clinical findings (P = .06).

CONCLUSIONS AND RELEVANCE

The use of ICGA may reduce the risk of partial skin flap necrosis in free flaps used in patients undergoing head and neck reconstruction who are at high risk of developing flap necrosis. Indocyanine green angiography imaging should be considered in any flap in which skin paddle viability is uncertain based on clinical findings and in patients in whom the skin paddle extends beyond the primary and adjacent angiosomes.

LEVEL OF EVIDENCE

3.

Authors+Show Affiliations

Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles.Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles2currently with the Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts.Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles3currently with the Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco.Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles.Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles.

Pub Type(s)

Comparative Study
Evaluation Studies
Journal Article

Language

eng

PubMed ID

26335298

Citation

Beckler, Andrew D., et al. "Assessment of Fibula Flap Skin Perfusion in Patients Undergoing Oromandibular Reconstruction: Comparison of Clinical Findings, Fluorescein, and Indocyanine Green Angiography." JAMA Facial Plastic Surgery, vol. 17, no. 6, 2015, pp. 422-6.
Beckler AD, Ezzat WH, Seth R, et al. Assessment of Fibula Flap Skin Perfusion in Patients Undergoing Oromandibular Reconstruction: Comparison of Clinical Findings, Fluorescein, and Indocyanine Green Angiography. JAMA Facial Plast Surg. 2015;17(6):422-6.
Beckler, A. D., Ezzat, W. H., Seth, R., Nabili, V., & Blackwell, K. E. (2015). Assessment of Fibula Flap Skin Perfusion in Patients Undergoing Oromandibular Reconstruction: Comparison of Clinical Findings, Fluorescein, and Indocyanine Green Angiography. JAMA Facial Plastic Surgery, 17(6), pp. 422-6. doi:10.1001/jamafacial.2015.0961.
Beckler AD, et al. Assessment of Fibula Flap Skin Perfusion in Patients Undergoing Oromandibular Reconstruction: Comparison of Clinical Findings, Fluorescein, and Indocyanine Green Angiography. JAMA Facial Plast Surg. 2015;17(6):422-6. PubMed PMID: 26335298.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Assessment of Fibula Flap Skin Perfusion in Patients Undergoing Oromandibular Reconstruction: Comparison of Clinical Findings, Fluorescein, and Indocyanine Green Angiography. AU - Beckler,Andrew D, AU - Ezzat,Waleed H, AU - Seth,Rahul, AU - Nabili,Vishad, AU - Blackwell,Keith E, PY - 2015/9/4/entrez PY - 2015/9/4/pubmed PY - 2016/4/5/medline SP - 422 EP - 6 JF - JAMA facial plastic surgery JO - JAMA Facial Plast Surg VL - 17 IS - 6 N2 - IMPORTANCE: Complications of partial flap necrosis contribute substantially to morbidity in patients who undergo head and neck reconstructive surgery. OBJECTIVE: To assess the usefulness of clinical findings, intraoperative fluorescein angiography, and intraoperative indocyanine green angiography (ICGA) for evaluation of flap skin paddle perfusion in patients undergoing oromandibular reconstruction who are at high risk of partial skin paddle necrosis. DESIGN, SETTING, AND PARTICIPANTS: Retrospective medical record review from May 21, 1996, to May 27, 2015, at a tertiary care academic medical center. Participants were 73 patients who underwent reconstruction of through-and-through defects of the mucosa, mandible, and skin using fibula free flaps that contained large bilobed skin paddles. MAIN OUTCOMES AND MEASURES: The rates of partial skin paddle necrosis and revision reconstructive surgery. RESULTS: The rates of partial flap necrosis were 8% (n = 2) among 25 patients in whom the skin paddle was trimmed based on ICGA and 33% (n = 16) among 48 patients in whom the skin paddle was trimmed according to clinical findings (P = .02). The rates of revision reconstructive surgery were 20% (5 of 25) when flap skin paddles were trimmed using ICGA and 42% (20 of 48) when trimmed per clinical findings (P = .06). CONCLUSIONS AND RELEVANCE: The use of ICGA may reduce the risk of partial skin flap necrosis in free flaps used in patients undergoing head and neck reconstruction who are at high risk of developing flap necrosis. Indocyanine green angiography imaging should be considered in any flap in which skin paddle viability is uncertain based on clinical findings and in patients in whom the skin paddle extends beyond the primary and adjacent angiosomes. LEVEL OF EVIDENCE: 3. SN - 2168-6092 UR - https://www.unboundmedicine.com/medline/citation/26335298/Assessment_of_Fibula_Flap_Skin_Perfusion_in_Patients_Undergoing_Oromandibular_Reconstruction:_Comparison_of_Clinical_Findings_Fluorescein_and_Indocyanine_Green_Angiography_ L2 - https://jamanetwork.com/journals/jamafacialplasticsurgery/fullarticle/10.1001/jamafacial.2015.0961 DB - PRIME DP - Unbound Medicine ER -