Clinical assessment of flap perfusion by fiberoptic fluorometry

Perfusion fluorometry, a method which quantifies tissue fluorescence after intravenous fluorescein injection, has been highly predictive of skin flap survival in animals. It is advantageous because it is objective, simple, noninvasive, repeatable, and can be used to monitor flap perfusion constantly by following both uptake and elimination of dye. We applied this method clinically to a variety of flaps used in head and neck surgery. All flaps with good fluorometric values survived totally. Based on experience with 37 flaps, fluorometric indices have been established that accurately predict necrosis. Serial dye injections have been used to document transient flap ischemia in the early postoperative period. Representative cases illustrating the advantages of fluorometry in flap assessment are presented.