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Bedside monitoring of free flaps using ICG-fluorescence angiography significantly improves detection of postoperative perfusion impairment#.
J Plast Surg Hand Surg 2019; 53(3):149-154JP

Abstract

After microvascular tissue transfer, free flaps require meticulous postoperative surveillance. The purpose of this study was to evaluate the effect and applicability of indocyanine green fluorescence angiography (ICG-FA) in bedside monitoring of free flaps postoperatively, especially considering its role in correctly identifying vascular thromboses. Between February 2012 and October 2015, 210 free flaps used for defect reconstruction were analyzed. The flaps were monitored bedside for flap perfusion compromise by clinical examination and by ICG-FA in a standardized procedure in the first 3 postoperative days. Data were evaluated retrospectively with respect to the etiology of the perfusion compromise with special focus on vascular thromboses and revision rates. In total, 23 vascular thromboses were identified. The combination of clinical examination and ICG-FA (85%) was most successful in determining the prevalence of vascular thromboses. In 41 cases, clinical and/or ICG-FA examinations indicated revision surgery. The flap salvage rate after revision was 77% (31 cases), which results in an overall flap survival rate of 96%. The revision rates were reduced over the study time from 22% in 2012 to 12% in 2015. ICG-FA as an adjunct to clinical examination of free flaps can help in correctly identifying vascular thromboses and can help decide if revision surgery is necessary in not obvious cases of perfusion compromise.

Authors+Show Affiliations

a Department of Surgery, Division of Plastic and Hand Surgery , University Hospital Zurich , Zürich , Switzerland.a Department of Surgery, Division of Plastic and Hand Surgery , University Hospital Zurich , Zürich , Switzerland.a Department of Surgery, Division of Plastic and Hand Surgery , University Hospital Zurich , Zürich , Switzerland.a Department of Surgery, Division of Plastic and Hand Surgery , University Hospital Zurich , Zürich , Switzerland.a Department of Surgery, Division of Plastic and Hand Surgery , University Hospital Zurich , Zürich , Switzerland.a Department of Surgery, Division of Plastic and Hand Surgery , University Hospital Zurich , Zürich , Switzerland.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30676191

Citation

Adelsberger, Rosmarie, et al. "Bedside Monitoring of Free Flaps Using ICG-fluorescence Angiography Significantly Improves Detection of Postoperative Perfusion Impairment#." Journal of Plastic Surgery and Hand Surgery, vol. 53, no. 3, 2019, pp. 149-154.
Adelsberger R, Fakin R, Mirtschink S, et al. Bedside monitoring of free flaps using ICG-fluorescence angiography significantly improves detection of postoperative perfusion impairment#. J Plast Surg Hand Surg. 2019;53(3):149-154.
Adelsberger, R., Fakin, R., Mirtschink, S., Forster, N., Giovanoli, P., & Lindenblatt, N. (2019). Bedside monitoring of free flaps using ICG-fluorescence angiography significantly improves detection of postoperative perfusion impairment#. Journal of Plastic Surgery and Hand Surgery, 53(3), pp. 149-154. doi:10.1080/2000656X.2018.1562457.
Adelsberger R, et al. Bedside Monitoring of Free Flaps Using ICG-fluorescence Angiography Significantly Improves Detection of Postoperative Perfusion Impairment#. J Plast Surg Hand Surg. 2019;53(3):149-154. PubMed PMID: 30676191.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Bedside monitoring of free flaps using ICG-fluorescence angiography significantly improves detection of postoperative perfusion impairment#. AU - Adelsberger,Rosmarie, AU - Fakin,Richard, AU - Mirtschink,Sophia, AU - Forster,Natasha, AU - Giovanoli,Pietro, AU - Lindenblatt,Nicole, Y1 - 2019/01/24/ PY - 2019/1/25/pubmed PY - 2019/5/17/medline PY - 2019/1/25/entrez KW - ICG KW - angiography KW - flap KW - microvascular surgery KW - monitoring SP - 149 EP - 154 JF - Journal of plastic surgery and hand surgery JO - J Plast Surg Hand Surg VL - 53 IS - 3 N2 - After microvascular tissue transfer, free flaps require meticulous postoperative surveillance. The purpose of this study was to evaluate the effect and applicability of indocyanine green fluorescence angiography (ICG-FA) in bedside monitoring of free flaps postoperatively, especially considering its role in correctly identifying vascular thromboses. Between February 2012 and October 2015, 210 free flaps used for defect reconstruction were analyzed. The flaps were monitored bedside for flap perfusion compromise by clinical examination and by ICG-FA in a standardized procedure in the first 3 postoperative days. Data were evaluated retrospectively with respect to the etiology of the perfusion compromise with special focus on vascular thromboses and revision rates. In total, 23 vascular thromboses were identified. The combination of clinical examination and ICG-FA (85%) was most successful in determining the prevalence of vascular thromboses. In 41 cases, clinical and/or ICG-FA examinations indicated revision surgery. The flap salvage rate after revision was 77% (31 cases), which results in an overall flap survival rate of 96%. The revision rates were reduced over the study time from 22% in 2012 to 12% in 2015. ICG-FA as an adjunct to clinical examination of free flaps can help in correctly identifying vascular thromboses and can help decide if revision surgery is necessary in not obvious cases of perfusion compromise. SN - 2000-6764 UR - https://www.unboundmedicine.com/medline/citation/30676191/Bedside_monitoring_of_free_flaps_using_ICG_fluorescence_angiography_significantly_improves_detection_of_postoperative_perfusion_impairment L2 - http://www.tandfonline.com/doi/full/10.1080/2000656X.2018.1562457 DB - PRIME DP - Unbound Medicine ER -