Intraoperative evaluation of skin-flap viability using laser-induced fluorescence of indocyanine green.

Laser-induced fluorescence of indocyanine green (ICG) is a new method for evaluating skin perfusion, which is superior to conventional fluorescein angiography. In a prospective clinical study ICG fluorescence video-angiography was used for the intraoperative evaluation of skin-flap perfusion. The results of ICG imaging were compared with clinical outcome 1 week postoperatively. Intraoperative ICG filling defects were always associated with delayed wound healing. In 50% of the patients, the regions of sloughing and epitheliolysis corresponded accurately to the regions of dye-filling deficits. All of the flaps without ICG filling defects healed primarily. These results suggest that ICG fluorescence is a sensitive tool for assessing nutritive blood flow in pedicled skin flaps with and without an axial vessel. Future clinical studies are required to establish critical threshold fluorescence indices that correlate with skin viability in the postoperative course.

[1]  J. Still,et al.  Evaluation of the circulation of reconstructive flaps using laser-induced fluorescence of indocyanine green. , 1999, Annals of plastic surgery.

[2]  S. Carroll,et al.  Acute Ischemic Preconditioning of Skeletal Muscle Prior to Flap Elevation Augments Muscle‐Flap Survival , 1997, Plastic and reconstructive surgery.

[3]  V Wienert,et al.  Infrared videoangiofluorography of the skin with indocyanine green--rat random cutaneous flap model and results in man. , 1994, Microvascular research.

[4]  C. Holm,et al.  Arterial thermodilution: an alternative to pulmonary artery catheter for cardiac output assessment in burn patients. , 2001, Burns : journal of the International Society for Burn Injuries.

[5]  H Ishihara,et al.  Detection of capillary protein leakage by glucose and indocyanine green dilutions during the early post-burn period. , 1998, Burns : journal of the International Society for Burn Injuries.

[6]  P. Cederna,et al.  The Effect of the Delay Phenomenon on the Vascularity of Rabbit Rectus Abdominis Muscles , 1997, Plastic and reconstructive surgery.

[7]  R L Walton,et al.  Surface Quantification of Injected Fluorescein as a Predictor of Flap Viability , 1983, Plastic and reconstructive surgery.

[8]  G. Larkin,et al.  Assessment of Microcirculation of an Axial Skin Flap Using Indocyanine Green Fluorescence Angiography , 1995, Plastic and reconstructive surgery.

[9]  J. McCraw,et al.  THE VALUE OF FLUORESCEIN IN PREDICTING THE VIABILITY OF ARTERIALIZED FLAPS , 1977, Plastic and reconstructive surgery.