Indocyanine Green Angiography in Salvage Planning: From Pedicled Supraclavicular Flap to Free Supraclavicular Flap

Abstract

The supraclavicular flap has gained popularity in recent years as a reliable and easily harvested flap with occasional anatomical variations in the course of the pedicle. In this case study, the excision of a cancer lesion on the face of 70-year-old female patient had resulted in a soft tissue defect of size 8 x 9 cm. The reconstruction of the surgical defect was done by using the supraclavicular perforator flap. The flap perforators were marked preoperatively with a handheld Doppler using indocyanine green angiography. During the flap dissection, the dominant perforator was determined by a selective clamping of each of the perforators guided by the indocyanine green angiography. Though the distal perforator was determined to be the dominant one, the pedicled flap design was found to be of inadequate length to reach the surgical defect. Consequently, the flap was turned into a free flap. The pedicle was anastomosed to the branches of facial vessels and survived completely. In conclusion, we believe that the dominant perforator may be identified by intraoperative indocyanine green angiography which would help in making a proper decision for flap design.

PreFlap: From Photoacoustic Tomography Images to Vascular Mapping Sheets for Improved Preoperative Flap Evaluation

“…Several studies have shown that ICG skin penetration depth is approximately 1 cm [38], [39]. However, other studies have reported that ICG can be detected up to 2 cm [6], [31]. Thus, we suggest that this difference in how the vessels are visualized, which affects the match rate, might be related to ICG depth resolution.…”

“…ICG is a water-soluble fluorescent dye with a spectral absorption range and peak emission of 750-800 nm and 832 nm, respectively. Once injected, visualization of dye distribution was performed with an 806 nm near infrared (NIR) laser with a penetration depth of up to 2 cm, which corresponds to the level of the fascia [6], [31]. The ICG emission signals were detected with PDE-neo (Hamamatsu Photonics Inc., Shizuoka, Japan).…”