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Predictive capability of near-infrared fluorescence angiography in submental perforator flap survival.

ABSTRACT: Perforator flaps have become increasingly popular in reconstructive surgery, as patients experience less donor-site morbidity than with conventional musculocutaneous flaps. Previously, the authors' laboratory described the intraoperative use of near-infrared fluorescence angiography for patient-specific perforator flap design. This study evaluates the predictive capability of near-infrared fluorescence angiography for flap survival in submental flap reconstruction.Near-infrared angiography was performed using indocyanine green at 0, 0.5, 24, 48, and 72 hours after surgery for flap creation in 12 pigs. A single perforator artery was preserved during flap creation based on location (central or noncentral) and dominance (dominant or nondominant). Venous drainage, arterial perfusion, and perfused area as a percentage of total flap area were analyzed. Clinical assessments of perfusion were compared with those made using near-infrared imaging and histology.Use of near-infrared fluorescence angiography immediately after flap creation accurately predicted areas of perfusion at 72 hours (p=0.0013), compared with the initial clinical assessment (p=0.3085). Identification of necrosis by histology at 72 hours correlated with near-infrared findings of insufficient arterial perfusion immediately after flap creation. No statistically significant differences in perfusion metrics were detected based on location or dominance of the preserved perforator; however, flaps containing central perforators had a higher percentage perfused area than those with noncentral perforators.The use of near-infrared angiography immediately after flap creation can predict areas of perfusion at 72 hours. This predictive capability may permit intraoperative revision of compromised flaps that have a high likelihood of failure.

SUBMITTER: Matsui A

PROVIDER: S-EPMC2974176 | biostudies-literature | 2010 Nov

REPOSITORIES: biostudies-literature

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Predictive capability of near-infrared fluorescence angiography in submental perforator flap survival.

Matsui Aya A Lee Bernard T BT Winer Joshua H JH Laurence Rita G RG Frangioni John V JV

Plastic and reconstructive surgery 20101101 5

<h4>Background</h4>Perforator flaps have become increasingly popular in reconstructive surgery, as patients experience less donor-site morbidity than with conventional musculocutaneous flaps. Previously, the authors' laboratory described the intraoperative use of near-infrared fluorescence angiography for patient-specific perforator flap design. This study evaluates the predictive capability of near-infrared fluorescence angiography for flap survival in submental flap reconstruction.<h4>Methods< ...[more]

PMID: 21042109

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Project description:ObjectivesTo explore the feasibility of making a submental perforator flap distal to the connecting line between the mastoid and the sternoclavicular joint under the guidance of neck-enhanced CT and repairing the postoperative defect of upper airway malignancy.Materials and methodsThis study retrospectively analysed 19 cases of upper airway malignant tumours treated in our department from January 2021 to September 2022, including 17 males and 2 females, aged 43-70 years.Site of lesions15 cases were in the laryngopharynx, 2 cases in the nasal cavity and paranasal sinus and 2 cases on the soft palate. All the lesions were malignant and at stages T2-4N0-2M0.Surgical methodThe extended submental perforator flap (size 22-15 × 6-7 cm) was prefabricated distal to the connecting line between the mastoid and the sternoclavicular joint. After tumour resection, the flap was used to repair the postoperative defect. Fifteen cases of laryngopharyngeal malignant tumours were repaired using the extended submental perforator flap with the vascular pedicle located on the opposite side of the tumour body. Two cases of nasal cavity and paranasal sinus tumours were repaired using the extended submental perforator flap combined with the temporalis muscle flap. The soft palate was completely removed in two patients with soft palate cancer and repaired using the folded extended submental perforator flap.ResultsBefore the surgery, the reflux vein was observed by neck-enhanced CT, including 12 cases returning to the internal jugular vein and 7 cases to the external jugular vein. All 19 cases in which flaps were used survived, and 1 case had a postoperative infection. All the patients had nasal feeding removed after surgery. The tracheal cannula was removed from the patients with laryngeal preservation, and the pronunciation was satisfactory. Among them, patients with soft palate cancer repair had mild nasal reflux symptoms with smooth breathing. During the follow-up period of 4-24 months, 18 patients had no tumour recurrence or metastasis, and 1 patient had cervical lymph node metastasis.ConclusionsThis study highlights the use of a submental perforator flap distal to the connecting line between the mastoid and the sternoclavicular joint to repair postoperative defects for upper airway malignancy as an innovative surgical approach that provides more tissue and good arteriovenous blood supply to adjacent sites. This method has high clinical value and provides an effective option for repairing postoperative defects of upper airway malignancy.

Project description:INTRODUCTION:Bowel viability can be difficult to evaluate during emergency surgery. Near-infrared (NIR) fluorescence angiography allows an intraoperative assessment of organ perfusion during elective surgery and might help to evaluate intestinal perfusion during emergency procedures. The aim of this study was to assess if NIR modified operative strategy during emergency surgery. MATERIALS AND METHODS:From July 2014 to December 2015, we prospectively evaluated all consecutive patients, who had NIR assessment during emergency surgery. Primary endpoint was the modification of operative strategy after the assessment with NIR. Secondary endpoints were general post-operative outcomes, including reoperation rate. RESULTS:Fifty-six patients were included in the study. Mean age was 64 ± 17 years. An exploratory laparoscopy was performed in 39% (n = 22) and an open surgery in 61% of cases (n = 34). Conversion rate to open surgery was 41% (n = 9). 32 patients had a bowel resection. In 32% of the cases (n = 18), the result of the NIR test led to a modification of the operative strategy. Among them, 33% (n = 6) had a larger resection or a resection, which was initially not planned. The other 12 patients (67%) had finally no resection, which was initially thought to be performed. Importantly, none of those patients needed a reoperation for ischemia. Mean time for performing NIR test was 167 s (± 121). Overall reoperation rate was 16.1% (n = 9). Two patients had an anastomotic leak. Eight patients (14.3%) died within the first 30 post-operative days; however, none of them presented a bowel ischemia or an anastomotic leak. CONCLUSION:NIR is an easy and short procedure, which can be performed during emergency surgery to assess bowel perfusion. It may help the surgeon to preserve intestinal length or to define the exact limits of resection. Overall, we report a modification of operative strategy in up to one-third of evaluated patients.

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Predictive capability of near-infrared fluorescence angiography in submental perforator flap survival.

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Predictive capability of near-infrared fluorescence angiography in submental perforator flap survival.

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