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Evaluation of Blood Perfusion in Skin Flaps

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Fluorescence-Guided Surgery
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Abstract

Reconstructive surgery using the skin flap is used in a variety of situations, including trauma and extended resection of malignant tumors. In order to assure surgical safety, it is important to confirm sufficient blood supply in the skin flap during surgery. In this chapter, we outline methods for the evaluation of graft perfusion by intraoperative fluorescence imaging using indocyanine green (ICG).

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References

  1. Hirigoyen MB, Blackwell KE, Zhang WX, et al. Continuous tissue oxygen tension measurement as a monitor of free-flap viability. Plast Reconstr Surg. 1997;99:763–73.

    Article  CAS  PubMed  Google Scholar 

  2. Futran ND, Stack BC Jr, Hollenbeak C, et al. Green light photoplethysmography monitoring of free flaps. Arch Otolaryngol Head Neck Surg. 2000;126:659–62.

    Article  CAS  PubMed  Google Scholar 

  3. Jones BM, Mayou BJ. The laser Doppler flowmeter for microvascular monitoring: a preliminary report. Br J Plast Surg. 1982;35:147–9.

    Article  CAS  PubMed  Google Scholar 

  4. Svensson H, Pettersson H, Svedman P. Laser doppler flowmetry and laser photometry for monitoring free flaps. Scand J Plast Reconstr Surg. 1985;19:245–9.

    CAS  PubMed  Google Scholar 

  5. Myers MB. Prediction of skin sloughs at the time of operation with the use of fluorescein dye. Surgery. 1962;51:158–62.

    PubMed  Google Scholar 

  6. Silverman DG, LaRossa DD, Barlow CH, et al. Quantification of tissue fluorescein delivery and prediction of flap viability with the fiberoptic. Plast Reconstr Surg. 1980;66:545–53.

    Article  CAS  PubMed  Google Scholar 

  7. Graham BH, Walton RL, Elings VB, et al. Surface quantification of injected fluorescein as a predictor of flap viability. Plast Reconstr Surg. 1983;71:826–31.

    Article  CAS  PubMed  Google Scholar 

  8. Thompson JG, Kerrigan CL. Dermofluorometry: thresholds for predicting flap survival. Plast Reconstr Surg. 1989;83:859–64.

    Article  Google Scholar 

  9. Flower RW, Hochheimer BF. Indocyanine green dye fluorescence and infrared absorption choroidal angiography performed simultaneously with fluorescein angiography. Johns Hopkins Med J. 1978;138:33–42.

    Google Scholar 

  10. Eren S, Rübben A, Krein R, et al. Assessment of microcirculation of an axial skin flap using indocyanine green fluorescence angiography. Plast Reconstr Surg. 1995;96:1636–49.

    Article  CAS  PubMed  Google Scholar 

  11. Rübben A, Eren S, Krain R, et al. Infrared videoangiofluorography of the skin with indocyanine green – rat random cutaneous flap model and results in man. Microvasc Res. 1994;47:240–51.

    Article  PubMed  Google Scholar 

  12. Still J, Law E, Dawson J, et al. Evaluation of the circulation of reconstructive flaps using laser-induced fluorescence of indocyanine green. Ann Plast Surg. 1999;42:266–74.

    Article  CAS  PubMed  Google Scholar 

  13. Holm C, Mayr M, Hoefter E, et al. Intraoperative evaluation of skin-flap viability using laser-induced fluorescence of indocyanine green. Br J Plast Surg. 2002;55:635–44.

    Article  CAS  PubMed  Google Scholar 

  14. Holm C, Tegeler J, Mayr M, et al. Monitoring free flaps using laser-induced fluorescence of indocyanine green: a preliminary experience. Microsurgery. 2002;22:278–87.

    Article  CAS  PubMed  Google Scholar 

  15. Phillips BT, Lanier ST, Conkling N, et al. Intraoperative perfusion techniques can accurately predict mastectomy skin flap necrosis in breast reconstruction: results of a prospective trial. Plast Reconstr Surg. 2012;129:778e–88e.

    Article  PubMed  Google Scholar 

  16. Sood M, Glat P. Potential of the SPY intraoperative perfusion assessment system to reduce ischemic complications in immediate postmastectomy Breast Reconstruction. Ann Surg Innov Res. 2013;7:9.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Duggal CS, Madni T, Losken A. An outcome analysis of intraoperative angiography for postmastectomy breast reconstruction. Aesthet Surg J. 2014;34:61–5.

    Article  PubMed  Google Scholar 

  18. Casey WJ, Connolly KA, Nanda A, et al. Indocyanine green laser angiography improves deep inferior epigastric perforator flap outcome following abdominal suction lipectomy. Plast Reconstr Surg. 2015;135:491–497e.

    Article  Google Scholar 

  19. La Padula S, Hersant B, Meningaud JP, et al. Intraoperative use of indocyanine green angiography for selecting a more reliable perforator of the anterolateral thigh flap: a comparison study. Microsurgery. 2018;38:738–44.

    Article  PubMed  Google Scholar 

  20. Losken A, Zenn MR, Hammel JA, et al. Assessment of zonal perfusion using intraoperative angiography during abdominal flap breast reconstruction. Plast Reconstr Surg. 2012;129:618e–24e.

    Article  CAS  PubMed  Google Scholar 

  21. Woodard CR, Most SP. Intraoperative angiography using laser-assisted indocyanine green imaging to map perfusion of forehead flaps. Arch Facial Plast Surg. 2012;14:263–9.

    Article  PubMed  Google Scholar 

  22. Kamolz LP, Andel H, Auer T, et al. Evaluation of skin perfusion by use of indocyanine green video angiography: rational design and planning of trauma surgery. J Trauma. 2006;61:635–41.

    Article  PubMed  Google Scholar 

  23. Krishnan KG, Schackert G, Steinmeier R. The role of near-infrared angiography in the assessment of post-operative venous congestion in a random pattern, pedicled Island and free flaps. Br J Plast Surg. 2005;58:330–8.

    Article  PubMed  Google Scholar 

  24. Holm C, Mayr M, Höfter E, et al. Assessment of the patency of microvascular anastomoses using microscope-integrated near-infrared angiography: a preliminary study. Microsurgery. 2009;29:509–14.

    Article  PubMed  Google Scholar 

  25. Kishi K, Imanishi N, Shimizu Y, et al. Alternative 1-step nasal reconstruction technique. Arch Facial Plast Surg. 2012;14:116–21.

    Article  PubMed  Google Scholar 

  26. Kishi K, Nakajima H, Imanishi N. Distally based greater saphenous venoadipofascial- sartorius muscle combined flap with venous anastomosis. Plast Reconstr Surg. 2007;119:1808–12.

    Article  CAS  PubMed  Google Scholar 

  27. Obana A, Miki T, Hayashi K, et al. Survey of complications of indocyanine green angiography in Japan. Am J Ophthalmol. 1994;118:749–53.

    Article  CAS  PubMed  Google Scholar 

  28. Starosoloski Z, Bhavane R, Ghaghada KB, et al. Indocyanine green fluorescence in the second near-infrared (NIR- II) window. PLoS One. 2017;12:e0187563.

    Article  Google Scholar 

  29. Carr JA, Franke D, Caram JR, et al. Shortwave infrared fluorescence imaging with the clinically approved near-infrared dye indocyanine green. Proc Natl Acad Sci U S A. 2018;115:4465–70.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Correspondence to Keisuke Okabe .

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Okabe, K., Kishi, K. (2023). Evaluation of Blood Perfusion in Skin Flaps. In: Ishizawa, T. (eds) Fluorescence-Guided Surgery. Springer, Singapore. https://doi.org/10.1007/978-981-19-7372-7_10

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  • DOI: https://doi.org/10.1007/978-981-19-7372-7_10

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  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-19-7371-0

  • Online ISBN: 978-981-19-7372-7

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