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Laser-induced fluorescence of indocyanine green: plastic surgical applications

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Abstract

The objective assessment of tissue perfusion is of utmost importance to plastic surgeons. Nevertheless, clinical observation remains the accepted gold standard for assessment of microcirculation. Dynamic laser fluorescence videography is a new technique for objective assessment of blood flow. We describe our clinical experience using this technique in plastic surgical patients. Possible implementations include evaluation of pedicle (random and axial pattern) flaps, monitoring of free tissue transfer and replants, and the objective determination of burn depth. Compared with standard clinical assessment techniques indocyanine green imaging provides significant additional information which allows a rational and evidence-based planning of surgery.

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References

  1. Eren S, Rubben A, Krein R, Larkin G, Hettich R (1995) Assessment of microcirculation of an axial skin flap using indocyanine green fluorescence angiography. Plast Reconstr Surg 96:1636

    Google Scholar 

  2. Eren S, Krein R, Hafemann B (1995) Objective evaluation of the microcirculation in the skin with indocyanine green angiography (ICGA). A method for the clinic? Handchir Mikrochir Plast Chir 27:307

    Google Scholar 

  3. Fischer JC, Parker PM, Shaw WW (1986) Waveform analysis applied to laser Doppler flowmetry. Microsurgery 7:67–71

    Google Scholar 

  4. Flower RW (1973) Injection technique for indocyanine green and sodium fluorescein dye angiography of the eye. Invest Ophthalmol 12:881

    Google Scholar 

  5. Fox IJ, Wood EH (1957) Applications of dilution curves recorded from the right side of the heart or venous circulation with the aid of a new indicator dye. Proc Mayo Clin 32:541

    Google Scholar 

  6. Graham B, Walton R, Elings V, Lewis F (1983) Surface quantification of injected fluorescein as a predictor of flap viability. Plast Reconstr Surg 71:826–833

    Google Scholar 

  7. Graham BH, Gordon L, Alpert BS, et al (1985) Serial quantitative skin surface fluorescence: a new method for post-operative monitoring of vascular perfusion in revascularized digits. J Hand Surg Am 10:226–230

    Google Scholar 

  8. Green HA, Bua D, Anderson R, Nishioka NS (1992) Burn depth estimation using indocyanine green fluorescence. Arch Dermatol 128:43–49

    Google Scholar 

  9. Harrison DH, Mott G (1989) Impedance monitoring for subcutaneous free flap transfers. Br J Plast Surg 42:318–323

    Google Scholar 

  10. Heimbach D, Engrav L, Grube B, Marvin J (1992) Burn depth: a review. World J Surg 16:10–15

    Google Scholar 

  11. Hlava P, Moserova J, Konigova R (1983) Validity of clinical assessment of the depth of a thermal burn. Acta Chir Plast 25:202–208

    Google Scholar 

  12. Holland AJ, Martin HC, Cass DT (2002) Laser doppler imaging prediction of burn wound outcome in children. Burns 28:11–17

    Google Scholar 

  13. Holm C, Melcer B, Hörbrand F, Wörl HH, Henckel von Donnersmarck G, Mühlbauer W (2000) Intrathoracic blood volume (ITBV) as an endpoint in resuscitation of the severely burned: an observational study of 24 patients. J Trauma 48:728–734

    Google Scholar 

  14. Holm C, Melcer B, Hörbrand F, Henckel von Donnersmarck G, Mühlbauer W (2001) Arterial thermodilution: an alternative to pulmonary artery catheter for cardiac output assessment in burn patients. Burns 27:161–166

    Google Scholar 

  15. Holm C, Tegeler J, Mayr M, Becker A, Pfeiffer UJ, Mühlbauer W (2002) Monitoring free flaps using laser-induced fluorescence of indocyanine green: a preliminary clinical experience. Microsurgery 22:278–287

    Google Scholar 

  16. Holm C, Mayr M, Höfter E, Becker A, Pfeiffer UJ, Mühlbauer W (2002) Perioperative evaluation of skin flaps using laser-induced fluorescence of indocyanine green. Br J Plast Surg 55:635–644

    Google Scholar 

  17. Jenkins SD, Sepka RS, Barwick WJ, et al (1987) Routine clinical use of laser Doppler flowmeter to monitor free tissue transfer: preliminary results. J Reconstr Microsurg 3:281–283

    Google Scholar 

  18. Jones JW, Glassford EJ, Hillman WCJ (1989) Remote monitoring of free flaps with telephonic transmission of photoplethysmograph waweforms. J Reconstr Microsurg 5:141–144

    Google Scholar 

  19. Kerrigan CL, Zelt RG, Daniel RK (1984) Secondary critical ischemia time of experimental skin flaps. Plast Reconstr Surg 74:522–526

    Google Scholar 

  20. Lange K, Boyd LJ (1943) The technique of the fluorescein test to determine the adequacy of circulation in peripheral vascular diseases, the circulation time and capillary permeability. Bull NY Med Coll Hosp 6:78

    Google Scholar 

  21. Leevy CM, Stein SW, Cherrik GR, Davidson CS (1959) Indocyanine green clearance: a test of liver excretory function. Clin Res 7:290

    Google Scholar 

  22. McCraw JB, Myers B, Shanklin KD (1997) The value of fluorescein in predicting the viability of arterialized flaps. Plast Reconstr Surg 60:710–719

    Google Scholar 

  23. McGregor IA (1980) Fundamental techniques of plastic surgery and their clinical surgical applications. Churchill Livingstone, Edinburgh

  24. McGregor IA, Jackson IT (1970) Design of skin flaps. Lancet 12:576

    Google Scholar 

  25. McGregor IA, Jackson IT (1972) The groin flap. Br J Plast Surg 25:3–16

    Google Scholar 

  26. Muckle TJ (1976) Plasma proteins binding of indocyanine green. Biochem Med 15:17

    Google Scholar 

  27. Rubben A, Eren S, Krein R, Younossi H, Böhler U, Wienert V (1994) Infrared videoangiofluorography of the skin with indocyanine green—Rat random cutaneous flap model and results in man. Microvasc Res 47:240–251

    Google Scholar 

  28. Schomacker KT, Torri A, Sandison DR, Sheridan RL, Nishioka NS (1997) Biodistribution of indocyanine green in a porcine burn model: light and fluorescence microscopy. J Trauma 43:813–819

    Google Scholar 

  29. Sheridan RL, Schomacker KT, Lucchina LC, et al (1995) Burn depth estimation by use of indocyanine green fluorescence: initial human trial. J Burn Care Rehabil 16:602–604

    Google Scholar 

  30. Sloan G, Reinisch J (1985) Flap physiology and the prediction of flap viability. Hand Clin 1:609–619

    Google Scholar 

  31. Solomon GA, Yaremchuk MJ, Manson PN (1986) Doppler ultrasound surface monitoring of both arterial and venous flow in clinical free tissue transfers. J Reconstr Microsurg 3:39–41

    Google Scholar 

  32. Still J, Law E, Dawson J, Bracci S, Island T, Holtz J (1999) Evaluation of the circulation of reconstructive flaps using laser-induced fluorescence of indocyanine green. Ann Plast Surg 42:266–274

    Google Scholar 

  33. Still JM, Law EJ, Klavuhn KG, Island TC, Holtz JZ (2001) Diagnosis of burn depth using laser-induced indocyanine fluorescence: a preliminary clinical trial. Burns 27:364–371

    Google Scholar 

  34. Svensson H, Pettersson H, Svedman P (1985) Laser Doppler flowmetry and laser photometry for monitoring free flaps. Scand J Plast Reconstr Surg 19:245–249

    Google Scholar 

  35. Tanzer TL, Horne JG (1982) The assessment of skin viability using fluorescein angiography prior to amputation. J Bone Joint Surg Am 64:880–882

    Google Scholar 

  36. Walkinshaw M, Holloway A, Bulkley A, Engrav LH (1987) Clinical evaluation of laser Doppler flow measurements in free flaps. Ann Plast Surg 18:212–217

    Google Scholar 

  37. Waterhouse N (1986) A review of 5 years experience of digital replantation. Ann R Coll Surg Engl 68:50–52

    Google Scholar 

  38. Webster MHC, Patterson J (1976) The photoelectric plethysmograph as a monitor of microvascular anastomoses. Br J Plast Surg 29:182–185

    Google Scholar 

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Acknowledgements

We thank David L. Wood, M.D., F.A.C.S., Long Beach, Calif., USA, for editing the English-language manuscript.

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Authors and Affiliations

  1. Department of Plastic and Hand Surgery, Burn Unit, Klinikum Bogenhausen, Technical University Munich, Englschalkingerstrasse 77, 81925 , Munich, Germany

    C. Holm, M. Mayr, J. Tegeler, A. Becker, U. Pfeiffer & W. Mühlbauer

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  1. C. Holm
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  2. M. Mayr
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  3. J. Tegeler
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  4. A. Becker
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  5. U. Pfeiffer
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  6. W. Mühlbauer
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Correspondence to C. Holm.

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Holm, C., Mayr, M., Tegeler, J. et al. Laser-induced fluorescence of indocyanine green: plastic surgical applications. Eur J Plast Surg 26, 19–25 (2003). https://doi.org/10.1007/s00238-003-0466-0

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  • DOI: https://doi.org/10.1007/s00238-003-0466-0

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