TY - JOUR

T1 - Indocyanine Green Fluorescence for Free-Flap Perfusion Imaging Revisited

T2 - Advanced Decision Making by Virtual Perfusion Reality in Visionsense Fusion Imaging Angiography

AU - Bigdeli, Amir Khosrow

AU - Gazyakan, Emre

AU - Schmidt, Volker Juergen

AU - Hernekamp, Frederick Jochen

AU - Harhaus, Leila

AU - Henzler, Thomas

AU - Kremer, Thomas

AU - Kneser, Ulrich

AU - Hirche, Christoph

N1 - © The Author(s) 2015.

PY - 2016/6

Y1 - 2016/6

N2 - BACKGROUND: Near-infrared indocyanine green video angiography (ICG-NIR-VA) has been introduced for free-flap surgery and may provide intraoperative flap designing as well as postoperative monitoring. Nevertheless, the technique has not been established in clinical routine because of controversy over benefits. Improved technical features of the novel Visionsense ICG-NIR-VA surgery system are promising to revisit the field of application. It features a unique real-time fusion image of simultaneous NIR and white light visualization, with highlighted perfusion, including a color-coded perfusion flow scale for optimized anatomical understanding.METHODS: In a feasibility study, the Visionsense ICG-NIR-VA system was applied during 10 free-flap surgeries in 8 patients at our center. Indications included anterior lateral thigh (ALT) flap (n = 4), latissimus dorsi muscle flap (n = 1), tensor fascia latae flap (n = 1), and two bilateral deep inferior epigastric artery perforator flaps (n = 4). The system was used intraoperatively and postoperatively to investigate its impact on surgical decision making and to observe perfusion patterns correlated to clinical monitoring.RESULTS: Visionsense ICG-NIR-VA aided assessing free-flap design and perfusion patterns in all cases and correlated with clinical observations. Additional interventions were performed in 2 cases (22%). One venous anastomosis was revised, and 1 flap was redesigned. Indicated by ICG-NIR-VA, 1 ALT flap developed partial flap necrosis (11%).CONCLUSIONS: The Visionsense ICG-NIR-VA system allowed a virtual view of flap perfusion anatomy by fusion imaging in real-time. The system improved decision making for flap design and surgical decisions. Clinical and ICG-NIR-VA parameters correlated. Its future implementation may aid in improving outcomes for free-flap surgery, but additional experience is needed to define its final role.

AB - BACKGROUND: Near-infrared indocyanine green video angiography (ICG-NIR-VA) has been introduced for free-flap surgery and may provide intraoperative flap designing as well as postoperative monitoring. Nevertheless, the technique has not been established in clinical routine because of controversy over benefits. Improved technical features of the novel Visionsense ICG-NIR-VA surgery system are promising to revisit the field of application. It features a unique real-time fusion image of simultaneous NIR and white light visualization, with highlighted perfusion, including a color-coded perfusion flow scale for optimized anatomical understanding.METHODS: In a feasibility study, the Visionsense ICG-NIR-VA system was applied during 10 free-flap surgeries in 8 patients at our center. Indications included anterior lateral thigh (ALT) flap (n = 4), latissimus dorsi muscle flap (n = 1), tensor fascia latae flap (n = 1), and two bilateral deep inferior epigastric artery perforator flaps (n = 4). The system was used intraoperatively and postoperatively to investigate its impact on surgical decision making and to observe perfusion patterns correlated to clinical monitoring.RESULTS: Visionsense ICG-NIR-VA aided assessing free-flap design and perfusion patterns in all cases and correlated with clinical observations. Additional interventions were performed in 2 cases (22%). One venous anastomosis was revised, and 1 flap was redesigned. Indicated by ICG-NIR-VA, 1 ALT flap developed partial flap necrosis (11%).CONCLUSIONS: The Visionsense ICG-NIR-VA system allowed a virtual view of flap perfusion anatomy by fusion imaging in real-time. The system improved decision making for flap design and surgical decisions. Clinical and ICG-NIR-VA parameters correlated. Its future implementation may aid in improving outcomes for free-flap surgery, but additional experience is needed to define its final role.

KW - Aged

KW - Feasibility Studies

KW - Female

KW - Fluorescein Angiography

KW - Follow-Up Studies

KW - Free Tissue Flaps/blood supply

KW - Graft Rejection

KW - Graft Survival

KW - Humans

KW - Indocyanine Green

KW - Male

KW - Middle Aged

KW - Myocutaneous Flap/blood supply

KW - Optical Imaging/methods

KW - Perfusion Imaging/methods

KW - Plastic Surgery Procedures/adverse effects

KW - Sampling Studies

U2 - 10.1177/1553350615610651

DO - 10.1177/1553350615610651

M3 - Journal article

C2 - 26474605

VL - 23

SP - 249

EP - 260

JO - Surgical Innovation

JF - Surgical Innovation

SN - 1553-3506

IS - 3

ER -