Quantitative Perfusion Assessment Using Indocyanine Green in Lower Extremity Perforator Flaps

Area of Science:

• Reconstructive Surgery
• Surgical Imaging
• Vascular Assessment

Background:

• Indocyanine-Green Fluorescence Angiography (ICG-FA) is crucial for assessing flap perfusion in reconstructive surgery.
• Subjective interpretation of ICG-FA poses challenges, particularly in complex lower extremity reconstructions.
• Objective, data-driven tools are needed to enhance perfusion assessment accuracy.

Purpose of the Study:

• To evaluate the utility of quantitative Indocyanine-Green Fluorescence Angiography (ICG-FA) in predicting perfusion-related complications.
• To compare quantitative perfusion parameters derived from ICG-FA in cases with and without complications.

Main Methods:

• Intraoperative ICG-FA was performed during lower extremity reconstructions using a surgical microscope.
• Fluorescence-time-curves (FTCs) were generated using specialized software for quantitative analysis.
• Perfusion parameters were compared across three cases: two with complications and one without.

Main Results:

• Subjective ICG-FA interpretation did not alter surgical management in any case.
• Quantitative analysis of ICG-FA revealed abnormal perfusion in flaps that later developed complications.
• Perfusion deficits were identified quantitatively, which were not apparent through conventional assessment.

Conclusions:

• Fluorescence-time-curves (FTCs) derived from ICG-FA data show potential in predicting perfusion-related complications.
• Integrating quantitative ICG-FA analysis can significantly advance reconstructive surgery, especially for lower extremities.
• Objective assessment via FTCs may improve patient outcomes and reduce the risk of flap loss.