Abstract
Reconstructive surgery has for objective to restore anatomical defects using flaps. We tested fluorescent angiography in reconstructive surgery using the Fluobeam™ device for flap planning and monitoring. A cadaveric study allowed validating the ergonomics to transfer this technology for clinical trials. A clinical study validated the relevance of fluorescent angiography for perforator flap planning. We compared it with the surgical dissection and with routine investigation. The same technology was also used for flap monitoring. Fluorescent angiography clearly identified flap complication (thrombosis) earlier than clinical assessment. Fluorescent angiography seems to be a good tool for flap planning and monitoring.
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Saint-Cyr M, Wong C, Schaverien M, Mojallal A, Rohrich RJ. The perforasome theory: vascular anatomy and clinical implication. Plast Reconstr Surg. 2009;124(5):1529–44.
Smit JM, Klein S, Werker PM. An overview of methods for vascular mapping in the planning of free flaps. J Plast Reconstr Aesth Surg. 2010;63(9):e674–82.
Iida H, Ohashi I, Kishimoto S, Umeda T, Hata Y. Preoperative assessment of anterolateral thigh flap cutaneous perforators by colour doppler flowmetry. Br J Plast Surg. 2003;56(1):21–5.
Rozen WM, Ashton MW, Stella DL, Ferris S, White DC, Phillips TJ, Taylor GI. Developments in perforator Imaging for the anterolateral thigh flap: CT angiography and CT-guided stereotaxy. Microsurgery. 2008;28(4):227–32.
Azuma R, Morimoto Y, Masumoto K. Detection of skin perforators by indocyanine green fluorescence nearly infrared angiography. Plast Reconstr Surg. 2008;122(4):1062–7.
Liu DZ, Mathes DW, Zenn MR, Neligan PC. The application of indocyanine green fluorescence angiography in plastic surgery. Microsurgery. 2011;27(6):355–64.
Giunta RE, Holzbach T, Taskov C, Holm PS, Brill T, Gansbacher B, et al. Prediction of flap necrosis with laser induced indocyanine green fluorescence in a rat model. Br J Plast Surg. 2005;58(5):695–701.
Lee BT, Matsui A, Hutteman M, Lin SJ, Winer JH, Laurence RG, et al. Intraoperative near-infrared fluorescence imaging in perforator flap reconstruction: current research and early clinical experience. J Reconstr Microsurg. 2010;26(1):59–65.
Onoda S, Azumi S, Hasegawa K, Kimata Y. Preoperative identification of perforator vessels by combining MDCT, doppler flowmetry, and ICG fluorescent angiography. Microsurgery. 2013;33(4):265–9.
Smit JM, Zeebregts CJ, Acosta R, Werker PM. Advancements in free flap monitoring in the last decade: a critical review. Plast Reconstr Surg. 2010;125(1):177–85.
Newman MI, Samson MC. The application of laser-assisted Indocyanine green fluorescent dye angiography in microsurgical breast reconstruction. J Reconstr Microsurg. 2009;25(1):21.
Holm C, Dornseifer U, Sturtz G, Basso G, Schuster T, Ninkovic M. The intrinsic transit time of free microvascular flaps: clinical and prognostic implications. Microsurgery. 2010;30(2):91–6.
Betz CS, Zhorzel S, Schachenmayr H, Stepp H, Matthias C, Hopper C, Harréus U. Endoscopic assessment of free flap perfusion in the upper aerodigestive tract using indocyanine green: a pilot study. J Plast Reconstr Aesthet Surg. 2013;66(5):667–74.
Disclosure: The clinical trial mentioned in this article was supported by a grant from GRAVIT-innovation (Grenoble-Alpes) and the Grenoble University Hospital clinical research management.
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Video 32.1
Visualization of fluorescent spots on the lateral side of the leg, after ICG injection to map perforator vessels of a right fibular flap (AVI 630 kb)
Video 32.2
Mapping of the perforator vessels in a fibular flap using a fluorescent ruler to improve accuracy (WMV 1,786 kb)
Video 32.3
Per-operative fluorescent angiography of a fibular flap. The fibular artery is illuminated on the center on the image first; the skin paddle is then illuminated on the right side; and last, the vein is illuminated on the left side of the artery (AVI 778 kb)
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Bettega, G. et al. (2015). Fluorescent Angiography for Flap Planning and Monitoring in Reconstructive Surgery. In: Dip, F., Ishizawa, T., Kokudo, N., Rosenthal, R. (eds) Fluorescence Imaging for Surgeons. Springer, Cham. https://doi.org/10.1007/978-3-319-15678-1_32
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DOI: https://doi.org/10.1007/978-3-319-15678-1_32
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-15677-4
Online ISBN: 978-3-319-15678-1
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