Intraoperative angiography using laser-assisted indocyanine green imaging to map perfusion of forehead flaps

To quantify the perfusion of forehead flaps and compare blood flow from the supratrochlear artery with vascular in-growth at the recipient bed.

Patients with nasal defects necessitating forehead flap closure were prospectively enrolled to study flap perfusion dynamics. Laser-assisted indocyanine green angiography was used to obtain the measurements. When possible, patients returned for weekly recording of flap perfusion from the recipient bed with the pedicle clamped. Analysis of the data was performed using SPY-Q software.

Six patients were prospectively enrolled. All patients had intraoperative angiography at flap transfer, pedicle division, and at least 1 postoperative visit between these surgical procedures. Flow was measured as a percentage of perfusion of normal surrounding tissue. A higher percentage of perfusion was seen at the distal end of the flap when compared with the pedicle when the pedicle was clamped. This phenomenon was seen as early as the 1-week postoperative visit.

This is the first study attempting to quantify forehead flap perfusion from the supratrochlear artery and recipient bed. Data obtained suggest evidence of vascular in-growth 1 week following flap transfer.