Enhancing Safety in Reconstructive Microsurgery Using Intraoperative Indocyanine Green Angiography
Ingo Ludolph1, Raymund E Horch1, Andreas Arkudas1
1Department 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.
Frontiers in Surgery
|July 24, 2019
Summary
Indocyanine Green angiography offers a reliable, real-time method for assessing free flap viability in reconstructive microsurgery. This technique enhances surgical decision-making and reduces flap-related complications.
Area of Science:
- Microsurgery
- Plastic Surgery
- Surgical Imaging
Background:
- Assessing free flap viability is crucial in reconstructive microsurgery.
- Current methods for tissue perfusion evaluation exist, but advancements are sought.
- Indocyanine Green (ICG) angiography is an emerging technique for plastic surgeons.
Purpose of the Study:
- To demonstrate the clinical value and application of ICG angiography in microsurgical free flap transfers.
- To showcase ICG angiography's utility in intraoperative assessment and postoperative monitoring.
- To highlight its role in decision-making during free flap surgery.
Main Methods:
- ICG angiography was employed in microsurgical free flap transfers from various donor sites.
- The technique was used for intraoperative assessment during the operation.
- Perforator selection, flap tailoring, blood flow, and anastomosis patency were evaluated.
Main Results:
- ICG angiography proved valid, reproducible, and easy to use.
- It reliably assessed the extent of arterially perfused tissue, including muscle and composite flaps.
- The real-time angiography showed high sensitivity in detecting poorly perfused areas, supporting clinical judgment.
Conclusions:
- ICG angiography is a valuable tool for intraoperative and postoperative free flap monitoring.
- It aids in reducing flap-related complications and enhances the possibilities of free flap surgery.
- The technique is versatile, applicable to various flap types and tissues.
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