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[Microscope-integrated intraoperative indocyanine green angiography in plastic surgery]
T Holzbach1, N Artunian, T A Spanholtz
1Handchirurgie, Plastische Chirurgie, Ästhetische Chirurgie, Ludwig-Maximilians-Universität München, München. T homas.Holzbach@med.LMU.de
Handchirurgie, Mikrochirurgie, Plastische Chirurgie : Organ Der Deutschsprachigen Arbeitsgemeinschaft Fur Handchirurgie : Organ Der Deutschsprachigen Arbeitsgemeinschaft Fur Mikrochirurgie Der Peripheren Nerven Und Gefasse : Organ Der V
|April 13, 2012
Summary
Indocyanine green (ICG) angiography integrated into operating microscopes provides real-time tissue perfusion assessment in microsurgery. This technique enhances flap design safety and allows immediate intervention for malperfusion, preventing flap loss.
Area of Science:
- Microsurgery
- Vascular Surgery
- Medical Imaging
Context:
- Assessing tissue perfusion is crucial for flap survival in microsurgery.
- Intraoperative malperfusion detection enables timely surgical intervention.
- Indocyanine green (ICG) angiography offers topographic perfusion analysis.
Purpose:
- To evaluate the utility of integrating Indocyanine green (ICG) angiography into an operating microscope for assessing microanastomoses and tissue perfusion in microsurgical free flaps.
- To analyze blood flow transit times between arterial and venous anastomoses.
- To assess the safety and reliability of ICG angiography for intraoperative flap evaluation.
Summary:
- The study analyzed 11 microsurgical free flaps using integrated ICG angiography.
- No flap loss or partial necrosis was observed.
- Average arterial-venous transit time was 32.8s, with differences noted between muscle (27.7s) and fasciocutaneous/perforator flaps (47.5s).
- ICG angiography detected one venous thrombosis missed by clinical tests, leading to immediate revision.
Impact:
- ICG angiography provides a reliable, safe, and effective "angiographic patency test" for intraoperative assessment of microanastomoses.
- Transit time analysis offers valuable insights into flap blood flow.
- The technique enhances safety in flap design, particularly for perforator flaps, by visualizing perfusion borders.