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Enhancing Safety in Reconstructive Microsurgery Using Intraoperative Indocyanine Green Angiography.
Front Surg 2019; 6:39FS

Abstract

Intraoperative assessing and postoperative monitoring of the viability of free flaps is of high relevance in reconstructive microsurgery. Today different methods for the evaluation of tissue perfusion are known. Indocyanine Green angiography is an emerging technique among plastic surgeons with a broad scope of applications especially in microsurgical free flap transfer. We demonstrate the value and clinical application of this technique based on representative selected cases where Indocyanine Green angiography was used in microsurgical free flap transfers from different anatomic donor sites during the operation. Hereby perforator selection, flap tailoring, changes of blood flow and patency of anastomoses was judged and decision making was based on the angiographic findings. This method has proven to be valid, reproducible and easy to use. The application is not limited to the evaluation of skin perfusion, but is also applicable to muscle tissue or chimeric or composite flaps. Reliable judgement is especially given for the extent of arterially perfused tissue following complete flap dissection. Moreover, this real-time angiography revealed a high sensitivity for the detection of poorly perfused flap areas, thus supporting the conventional clinical judgement and reducing complications. In summary Indocyanine Green angiography has the potential to reduce flap related complications and to contribute to enhancing and extending the possibilities of free flap surgery.

Authors+Show Affiliations

Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital of Erlangen, Friedrich-Alexander-University of Erlangen-Nuernberg FAU, Erlangen, Germany.Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital of Erlangen, Friedrich-Alexander-University of Erlangen-Nuernberg FAU, Erlangen, Germany.Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital of Erlangen, Friedrich-Alexander-University of Erlangen-Nuernberg FAU, Erlangen, Germany.Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital of Erlangen, Friedrich-Alexander-University of Erlangen-Nuernberg FAU, Erlangen, Germany.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31334246

Citation

Ludolph, Ingo, et al. "Enhancing Safety in Reconstructive Microsurgery Using Intraoperative Indocyanine Green Angiography." Frontiers in Surgery, vol. 6, 2019, p. 39.
Ludolph I, Horch RE, Arkudas A, et al. Enhancing Safety in Reconstructive Microsurgery Using Intraoperative Indocyanine Green Angiography. Front Surg. 2019;6:39.
Ludolph, I., Horch, R. E., Arkudas, A., & Schmitz, M. (2019). Enhancing Safety in Reconstructive Microsurgery Using Intraoperative Indocyanine Green Angiography. Frontiers in Surgery, 6, p. 39. doi:10.3389/fsurg.2019.00039.
Ludolph I, et al. Enhancing Safety in Reconstructive Microsurgery Using Intraoperative Indocyanine Green Angiography. Front Surg. 2019;6:39. PubMed PMID: 31334246.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Enhancing Safety in Reconstructive Microsurgery Using Intraoperative Indocyanine Green Angiography. AU - Ludolph,Ingo, AU - Horch,Raymund E, AU - Arkudas,Andreas, AU - Schmitz,Marweh, Y1 - 2019/07/02/ PY - 2019/01/06/received PY - 2019/06/13/accepted PY - 2019/7/24/entrez PY - 2019/7/25/pubmed PY - 2019/7/25/medline KW - ICG KW - Indocyanine Green angiography KW - free flap KW - imaging KW - microsurgery SP - 39 EP - 39 JF - Frontiers in surgery JO - Front Surg VL - 6 N2 - Intraoperative assessing and postoperative monitoring of the viability of free flaps is of high relevance in reconstructive microsurgery. Today different methods for the evaluation of tissue perfusion are known. Indocyanine Green angiography is an emerging technique among plastic surgeons with a broad scope of applications especially in microsurgical free flap transfer. We demonstrate the value and clinical application of this technique based on representative selected cases where Indocyanine Green angiography was used in microsurgical free flap transfers from different anatomic donor sites during the operation. Hereby perforator selection, flap tailoring, changes of blood flow and patency of anastomoses was judged and decision making was based on the angiographic findings. This method has proven to be valid, reproducible and easy to use. The application is not limited to the evaluation of skin perfusion, but is also applicable to muscle tissue or chimeric or composite flaps. Reliable judgement is especially given for the extent of arterially perfused tissue following complete flap dissection. Moreover, this real-time angiography revealed a high sensitivity for the detection of poorly perfused flap areas, thus supporting the conventional clinical judgement and reducing complications. In summary Indocyanine Green angiography has the potential to reduce flap related complications and to contribute to enhancing and extending the possibilities of free flap surgery. SN - 2296-875X UR - https://www.unboundmedicine.com/medline/citation/31334246/Enhancing_Safety_in_Reconstructive_Microsurgery_Using_Intraoperative_Indocyanine_Green_Angiography_ L2 - https://dx.doi.org/10.3389/fsurg.2019.00039 DB - PRIME DP - Unbound Medicine ER -