Indocyanine green fluorescence videoangiography for reliable variations of supraclavicular artery flaps

Abstract

Background Pedicled flaps are useful for reconstructive surgery. Previously, we often used vascularized supraclavicular flaps, especially for head and neck reconstruction, but then shifted to using thoracic branch of the supraclavicular artery (TBSA) flaps. However, limited research exists on the anatomy of TBSA flaps and on the use of indocyanine green (ICG) fluorescence videoangiography for supraclavicular artery flaps. We utilized ICG fluorescence videoangiography to harvest reliable flaps in reconstructive operations, and describe the results herein. Methods Data were retrospectively reviewed from six patients (five men and one woman: average age, 54 years; range, 48–60 years) for whom ICG videoangiography was performed to observe the skin perfusion of a supraclavicular flap after it was raised. Areas where the flap showed good enhancement were considered to be favorable for flap survival. The observation of ICG dye indicated good skin perfusion, which is predictive of flap survival; therefore, we trimmed any areas without dye filling and used the remaining viable part of the flap. Results The flaps ranged in size from 13×5.5 cm to 17×6.5 cm. One patient received a conventional supraclavicular flap, four patients received a TBSA flap, and one patient received a flap that was considered to be intermediate between a supraclavicular flap and a TBSA flap. The flaps completely survived in all cases, and no flap necrosis was observed. Conclusions The TBSA flap is very useful in reconstructive surgery, and reliable flaps could be obtained by using ICG fluorescence videoangiography intraoperatively.

The Use of Indocyanine Green Angiography for Cosmetic and Reconstructive Assessment in the Head and Neck

“…Multiple near-infrared video camera systems have been used for ICG angiography in the head and neck region. The most popular are the SPY Elite system (NOVADAQ Technologies Inc.), 1,21 the IC View System (Pulsion Medical Systems), the PDE-Neo system (Hamamatsu Photonics), 22,23 IR800 (Carl Zeiss AG), and Flow800 (OPMI Pentero, Carl Zeiss AG). 24 Some systems used filtered endoscope-integrated systems such as red/near-infrared excitation (filtered Xenon Short Arc lamp, Karl Storz) coupled to an infrared-sensitive threechip CCD camera (Karl Storz).…”

“…This range includes 0.1 mg/kg, 23 0.2 mg/kg, 27 0.3 mg/ kg, 3 0.5 mg/kg, 24 and up to 1 mg/kg in the evaluation of large vessels (e.g., jugular vein thrombosis). 28 Fixed doses in head and neck reconstruction have also been reported according to the region assessed, which include 5 mg in forehead flaps and supraclavicular flaps, 1,22,25 6.25 mg in deep plane facelift, 29 7.5 mg in radial forearm and fibula free flaps, 30 10 mg in salvage laryngectomy, 14 12.5 mg in anterolateral thigh flaps, 31 and up to 25 mg in nasoseptal flaps. 32,33 After the bolus is injected in a central or peripheral line, usually a 10-mL 0.9% normal saline flush is administered.…”

“…It has been successfully used in designing fasciocutaneous flaps such as the supraclavicular flap using either its artery or its artery's thoracic branch. 22 In these flaps, territories with filling defects can anticipate perfusion compromise that can result in tissue loss and dehiscence. This is of paramount importance in reconstructing the aerodigestive tract where less perfused edges are trimmed to avoid fistulas.…”

“…Examples of intraoperative modifications include perfusion improvement with tension stitch release, change in the pivotal point, or edge trimming. 22,39 We have used ICG angiography to evaluate lip reconstruction in three cases using a pedicled Abbe flap, as shown in ►Fig. 4.…”

“…7. An average perfusion (SD) of the distal flap was 89% (22), with an average of 23 days interval between both stages. 25 This study has shown a significant difference between perfusion parameters after pedicle clamping (being higher in the beginning of the second stage) and after pedicle division.…”