Determination of a Perfusion Threshold in Experimental Perforator Flap Surgery Using Indocyanine Green Angiography

Abstract

Indocyanine green (ICG) angiography has been used in the evaluation of flap perfusion but the viability threshold has not been elucidated. In this study, we determined the threshold by comparing perfusion, using ICG imaging (SPY imaging system, LifeCell Corporation), to clinical evidence of nonviability in rat abdominal perforator flaps. Abdominal flaps, based on a single perforator, were elevated and re-inset in Sprague-Dawley rats. ICG imaging and clinical assessments were conducted preoperatively, as well as 0, 24, and 48 hours postoperatively. SPY-Q software allowed standardization of the perforator's perfusion for comparison purposes. A total of 278 random percentage measurements were made from postoperative day 0 giving a mean (SE) percentage perfusion of 26.8% (1.6%) and 59.1% (1.3%), respectively, for necrosis and survival (P<0.05). We demonstrate that ICG angiography can be readily analyzed in a perforator flap environment allowing a determination of the perfusion threshold.

The transverse musculo‐cutaneous gracilis flap for breast reconstruction: How to avoid complications

“…However, in our interpretable case, we did not find any significant correlations between ICG flap fluorescence and the risks of partial flap necrosis. Currently, further research is required to clearly determine the perfusion threshold corresponding to viability . The double TMG flap transfer for unilateral reconstruction is another solution to increase reconstruction volume.…”

Use of Perforator-Based Fasciocutaneous Flaps for Pressure Sore Reconstruction: Single-Perforator-Based Versus Multiple-Perforator-Based Flaps

“…Second, the perforasome size was not evaluated preoperatively to assess the difference between groups, and the perforasome size relied on wound size and the experience of the surgeon. Intraoperative indocyanine angiography may be useful to evaluate perfusion and adjust the flap size in future procedures [54,55]. Third, most of the wounds reconstructed by using perforator-based flaps were located in the back-hip-sacrum region.…”

Rotation arc of pedicled anterolateral thigh flap for abdominal wall reconstruction: How far can it reach?

“…Therefore, in situations where we need to employ distally located perforators to earn additional CRD, we should carefully examine during the operation whether the flap has sufficient blood supply, by using techniques such as indocyanine green angiography. 27,28 This study was conducted with cadavers fixed with formalin, which hardens tissues. Therefore, there might be criticism that the measured extension of the flaps is likely to be shorter than it should be, and that the flaps can be transferred to more cranial positions in actual operations.…”