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Indocyanine Green Fluorescence for Free-Flap Perfusion Imaging Revisited: Advanced Decision Making by Virtual Perfusion Reality in Visionsense Fusion Imaging Angiography.
Surg Innov 2016; 23(3):249-60SI

Abstract

BACKGROUND

Near-infrared indocyanine green video angiography (ICG-NIR-VA) has been introduced for free-flap surgery and may provide intraoperative flap designing as well as postoperative monitoring. Nevertheless, the technique has not been established in clinical routine because of controversy over benefits. Improved technical features of the novel Visionsense ICG-NIR-VA surgery system are promising to revisit the field of application. It features a unique real-time fusion image of simultaneous NIR and white light visualization, with highlighted perfusion, including a color-coded perfusion flow scale for optimized anatomical understanding.

METHODS

In a feasibility study, the Visionsense ICG-NIR-VA system was applied during 10 free-flap surgeries in 8 patients at our center. Indications included anterior lateral thigh (ALT) flap (n = 4), latissimus dorsi muscle flap (n = 1), tensor fascia latae flap (n = 1), and two bilateral deep inferior epigastric artery perforator flaps (n = 4). The system was used intraoperatively and postoperatively to investigate its impact on surgical decision making and to observe perfusion patterns correlated to clinical monitoring.

RESULTS

Visionsense ICG-NIR-VA aided assessing free-flap design and perfusion patterns in all cases and correlated with clinical observations. Additional interventions were performed in 2 cases (22%). One venous anastomosis was revised, and 1 flap was redesigned. Indicated by ICG-NIR-VA, 1 ALT flap developed partial flap necrosis (11%).

CONCLUSIONS

The Visionsense ICG-NIR-VA system allowed a virtual view of flap perfusion anatomy by fusion imaging in real-time. The system improved decision making for flap design and surgical decisions. Clinical and ICG-NIR-VA parameters correlated. Its future implementation may aid in improving outcomes for free-flap surgery, but additional experience is needed to define its final role.

Authors+Show Affiliations

University of Heidelberg, Heidelberg, Germany.University of Heidelberg, Heidelberg, Germany.University of Heidelberg, Heidelberg, Germany.University of Heidelberg, Heidelberg, Germany.University of Heidelberg, Heidelberg, Germany.Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.University of Heidelberg, Heidelberg, Germany.University of Heidelberg, Heidelberg, Germany.University of Heidelberg, Heidelberg, Germany Christoph.Hirche@bgu-ludwigshafen.de.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26474605

Citation

Bigdeli, Amir Khosrow, et al. "Indocyanine Green Fluorescence for Free-Flap Perfusion Imaging Revisited: Advanced Decision Making By Virtual Perfusion Reality in Visionsense Fusion Imaging Angiography." Surgical Innovation, vol. 23, no. 3, 2016, pp. 249-60.
Bigdeli AK, Gazyakan E, Schmidt VJ, et al. Indocyanine Green Fluorescence for Free-Flap Perfusion Imaging Revisited: Advanced Decision Making by Virtual Perfusion Reality in Visionsense Fusion Imaging Angiography. Surg Innov. 2016;23(3):249-60.
Bigdeli, A. K., Gazyakan, E., Schmidt, V. J., Hernekamp, F. J., Harhaus, L., Henzler, T., ... Hirche, C. (2016). Indocyanine Green Fluorescence for Free-Flap Perfusion Imaging Revisited: Advanced Decision Making by Virtual Perfusion Reality in Visionsense Fusion Imaging Angiography. Surgical Innovation, 23(3), pp. 249-60. doi:10.1177/1553350615610651.
Bigdeli AK, et al. Indocyanine Green Fluorescence for Free-Flap Perfusion Imaging Revisited: Advanced Decision Making By Virtual Perfusion Reality in Visionsense Fusion Imaging Angiography. Surg Innov. 2016;23(3):249-60. PubMed PMID: 26474605.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Indocyanine Green Fluorescence for Free-Flap Perfusion Imaging Revisited: Advanced Decision Making by Virtual Perfusion Reality in Visionsense Fusion Imaging Angiography. AU - Bigdeli,Amir Khosrow, AU - Gazyakan,Emre, AU - Schmidt,Volker Juergen, AU - Hernekamp,Frederick Jochen, AU - Harhaus,Leila, AU - Henzler,Thomas, AU - Kremer,Thomas, AU - Kneser,Ulrich, AU - Hirche,Christoph, Y1 - 2015/10/15/ PY - 2015/10/18/entrez PY - 2015/10/18/pubmed PY - 2017/4/25/medline KW - 3D anatomy KW - ICG KW - Visionsense KW - angiography KW - free flap KW - fusion image KW - indocyanine green KW - microsurgery SP - 249 EP - 60 JF - Surgical innovation JO - Surg Innov VL - 23 IS - 3 N2 - BACKGROUND: Near-infrared indocyanine green video angiography (ICG-NIR-VA) has been introduced for free-flap surgery and may provide intraoperative flap designing as well as postoperative monitoring. Nevertheless, the technique has not been established in clinical routine because of controversy over benefits. Improved technical features of the novel Visionsense ICG-NIR-VA surgery system are promising to revisit the field of application. It features a unique real-time fusion image of simultaneous NIR and white light visualization, with highlighted perfusion, including a color-coded perfusion flow scale for optimized anatomical understanding. METHODS: In a feasibility study, the Visionsense ICG-NIR-VA system was applied during 10 free-flap surgeries in 8 patients at our center. Indications included anterior lateral thigh (ALT) flap (n = 4), latissimus dorsi muscle flap (n = 1), tensor fascia latae flap (n = 1), and two bilateral deep inferior epigastric artery perforator flaps (n = 4). The system was used intraoperatively and postoperatively to investigate its impact on surgical decision making and to observe perfusion patterns correlated to clinical monitoring. RESULTS: Visionsense ICG-NIR-VA aided assessing free-flap design and perfusion patterns in all cases and correlated with clinical observations. Additional interventions were performed in 2 cases (22%). One venous anastomosis was revised, and 1 flap was redesigned. Indicated by ICG-NIR-VA, 1 ALT flap developed partial flap necrosis (11%). CONCLUSIONS: The Visionsense ICG-NIR-VA system allowed a virtual view of flap perfusion anatomy by fusion imaging in real-time. The system improved decision making for flap design and surgical decisions. Clinical and ICG-NIR-VA parameters correlated. Its future implementation may aid in improving outcomes for free-flap surgery, but additional experience is needed to define its final role. SN - 1553-3514 UR - https://www.unboundmedicine.com/medline/citation/26474605/Indocyanine_Green_Fluorescence_for_Free_Flap_Perfusion_Imaging_Revisited:_Advanced_Decision_Making_by_Virtual_Perfusion_Reality_in_Visionsense_Fusion_Imaging_Angiography_ L2 - http://journals.sagepub.com/doi/full/10.1177/1553350615610651?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -