Assessment of Pedicled and Free Flap Perfusion

  • Vahe Fahradyan
  • Michael J. Annunziata
  • Risal S. Djohan
  • Graham S. SchwarzEmail author


Pedicled and free flaps have become major instruments in the reconstruction of complex body defects. Traditionally used clinical signs such as flap color, capillary refill time, temperature, and Doppler ultrasound assessment of the vascular pedicle remain the gold standard for flap evaluation. Indocyanine green angiography is a safe, quick, and repeatable imaging technique that can be utilized to help decision making in pedicled and free flap surgery. Here we discuss the application of indocyanine green angiography in pre-, intra-, and postoperative settings to identify pedicle location, evaluate tissue perfusion, visualize anastomotic patency, detect arterial insufficiency or venous congestion, help design flaps, and avoid postoperative complications.


Free flap ICG Fluorescent angiography Indocyanine green Flap perfusion Intraoperative imaging Perforator flap Anastomotic patency Perforator mapping 

Supplementary material

Video 27.1

Preoperative mapping of DIEP flap perforators (MP4 126573 kb)

Video 27.2

Assessment of tissue perfusion following DIEP flap elevation (MP4 303557 kb)

Video 27.3

Assessment of anastomoses patency following DIEP transfer to recipient zone (MP4 143960 kb)

Video 27.4

Assessment of pedicled parascapular flap perfusion (MP4 243881 kb)

Video 27.5

Assessment of DIEP flap perfusion following final flap inset (MP4 107357 kb)


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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Vahe Fahradyan
    • 1
  • Michael J. Annunziata
    • 2
  • Risal S. Djohan
    • 1
  • Graham S. Schwarz
    • 1
    Email author
  1. 1.Department of Plastic SurgeryDermatology and Plastic Surgery Institute, Cleveland ClinicClevelandUSA
  2. 2.Case Western Reserve University School of MedicineClevelandUSA

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