Indocyanine green videoangiography‐assisted prediction of flap necrosis in the rat epigastric flap using the flow<sup>®</sup> 800 tool

Mücke, Thomas; Fichter, Andreas M.; Schmidt, Leonard H.; Mitchell, David A.; Wolff, Klaus‐Dietrich; Ritschl, Lucas M.

doi:10.1002/micr.30072

Cited by 25 publications

(31 citation statements)

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“…www.nature.com/scientificreports www.nature.com/scientificreports/ laser-Doppler flowmetry and tissue spectrophotometry, tissue oximetry monitoring, infrared thermography and indocyanine green-(ICG-) videoangiography [8][9][10][11][12][13][14][15] .…”

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confidence: 99%

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A comparative analysis using flowmeter, laser-Doppler spectrophotometry, and indocyanine green-videoangiography for detection of vascular stenosis in free flaps

Mücke

Hapfelmeier

Schmidt

et al. 2020

Sci Rep

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The effects of gradual vascular occlusion on the blood supply of perfused areas are poorly described. Information relating to the comparison of flap monitoring techniques is lacking. Varying stenotic conditions (0%, 25%, 50%, 75% and 100%) were generated on purpose at the A. and V. femoralis in the rat model. Analyses included flowmeter, simultaneous laser-Doppler flowmetry and tissue spectrophotometry (O2C) and indocyanine green-(ICG-) videoangiography with integrated FLOW 800 tool. A Random Forests prediction model was used to analyse the importance of each method to diagnose the stenotic conditions. The ability to discriminate and to accurately estimate the probability of stenosis was assessed by Receiver Operating Characteristic (ROC) curves and calibration plots. Blood flow changes for all modalities were described in detail. Flowmeter displayed earliest a linear decrease as a result of increasing stenosis. A stenosis of 50% degrees was most difficult to detect correctly. The combination of flowmeter and ICG-videoangiography showed high diagnostic power for each stenotic situation (area under the Roc > 0.79). Flowmeter and ICG-videoangiography showed to be most relevant in detection of varying stenotic conditions and may change the clinical outcome. The O2C showed less effect on varying stenotic situations as the only surface monitoring device. The microvascular free tissue transfer has revolutionised reconstructive microsurgery and has improved the patients' functional outcome 1. Despite the well documented co-morbidities of patients undergoing head and neck surgery, free flap surgery has contributed to a continuous improvement in the patient-reported and clinical outcomes 2-4. Due to the significant patient co-morbidities and the complexity of the operations, this patient cohort has a high free flap failure rate. A successful outcome necessitates a detailed pre-, intra-and postoperative patient screening in addition to the free flap monitoring, for at least the first 72 hours, postoperatively. The reasons for free flap failures are commonly vascular (thrombosis, endothelial damage) or extravascular, (hematoma, kinking, twisting) in origin. Flap necrosis invariably leads to a prolonged hospital stay and may result in mortality due to poor physiological reserves. There is a definitive window of surgical intervention that must not be missed, for the salvage operation to be successful 5,6. For this reason, the routine postoperative free flap monitoring has to be effective, reproducible and reliable. Free flap monitoring techniques vary and may include the clinical observation, pinprick testing and handheld Doppler 7. More sophisticated, objective methods include simultaneous

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“…ICG-videoangiography was introduced into reconstructive free flap surgery in the last 20 years. More recently, this technique was also applied for the immediate analysis of patency following microvascular anastomosis or to predict the incidence of necrosis on the basis of only one measurement as an integrated system in the operating microscope 15,17,18 .…”

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A comparative analysis using flowmeter, laser-Doppler spectrophotometry, and indocyanine green-videoangiography for detection of vascular stenosis in free flaps

Mücke

Hapfelmeier

Schmidt

et al. 2020

Sci Rep

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“…Blood flow after one hour under continued anesthesia was assessed using the OPMI ® Pentero ® integrated near-infrared videoangiography detection system with the FLOW ® 800 tool (INFRARED 800; Carl Zeiss Meditec AG; Oberkochen, Germany) 9,13 . As previously decribed in detail, the ICG dye (ICG-PULSION; Pulsion Medical System AG; Munich, Germany) was injected weight-adapted intravenously (0.3 mg/kg body weight, 25 mg dissolved in 5 ml sterile water) as a bolus into the femoral vein using a microcatheter (Premicath; VYGON GmbH & Co. KG; Aachen, Germany) 14 . The ICG videoangiography started immediately after injection and was recorded in real time over a period of 120 seconds at a fixed working distance of 300 mm and with a 15-fold magnification.…”

Section: Icg Videoangiographymentioning

confidence: 99%

“…All data were immediately analyzed and stored. The detection and FLOW ® 800 analyses using a integrated mathematical softwaretool (FLOW ® 800; Carl Zeiss AG; Oberkochen, Germany) is described earlier in detail 14,15 . The resulting fluorescence intensity was recorded as arbitrary units (AU) and both color encoded figures as well as angiographies were analyzed by two independent, blinded investigators for the detection of thrombus formation (TM and CW).…”

Section: Icg Videoangiographymentioning

confidence: 99%

Detection of thrombosis in microvessels with indocyanine green videoangiography

Mücke

Wolff

Fichter

et al. 2018

British Journal of Oral and Maxillofacial Surgery

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Atherosclerosis is a systemic condition that is responsible for many diseases, and becomes a problem in cases where plaques form at several sites. The formation of a thrombotic embolus may jeopardise vascular operations, including microvascular anastomoses in replantation procedures or free tissue transfers. A mobile imaging tool for the detection of thrombosis preoperatively or intraoperatively would be valuable. An intimal injury, simulating removal of atherosclerotic plaques, was made microsurgically in 60 rat aortas, and results were analysed macroscopically, histologically, and with intraoperative indocyanine green (ICG) videoangiography immediately postoperatively. The Spearman and Pearson correlation tests were used to compare the three techniques. The sensitivity and specificity of ICG videoangiography was calculated in relation to both macroscopic and histological results. Detection of thrombosis was possible in 25 cases, and in 18 cases no thrombosis was correctly diagnosed by all methods used. In 31 of 60 specimens formation of thrombus was detected histologically, and in 29 of 60 examinations it was detected clinically, which yielded a correlation of 93.5% between the two examinations. Macroscopic analysis correlated better with ICG videoangiography (sensitivity 86.2% and specificity 64.5%) than histological observations (sensitivity 80.6% and specificity 62.1%). There was a significant correlation among all comparisons (each p≤0.001) with correlation indexes of 0.94, 0.52, and 0.44 for macroscopic/histological, clinical/ICG videoangiographic, and ICG videoangiographic/histological results, respectively. Our results show that ICG videoangiography is an important method for the detection of formation of acute thrombi and may be an important tool in vascular procedures.

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“…This method is safe for patient use, can be used at the bedside or intraoperatively, and allows for multiple repeat assessments within a short period of time. 18 The usefulness of ICG angiography for soft-tissue 19 and vascular assessment 20 is undisputed. 18 Only recently, the feasibility of osseous flap perfusion assessment using ICG angiography has been demonstrated in an animal model, 16 cadavers, 17 and the clinical setting.…”

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Effect of Segment Length and Number of Osteotomy Sites on Cancellous Bone Perfusion in Free Fibula Flaps

Fichter

Ritschl

Georg

et al. 2018

J reconstr Microsurg

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This study demonstrates the feasibility of cancellous bone perfusion analysis using ICG and can serve as a basis for future bone perfusion studies. Additional osteotomies and short segment length negatively affects cancellous bone perfusion of the distal fibula segment in free fibula flaps. The extent to which the observed decrease in arterial inflow to the distal fibula segment affects the further course of healing needs to be addressed in future studies.

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Indocyanine green videoangiography‐assisted prediction of flap necrosis in the rat epigastric flap using the flow^® 800 tool

Abstract: This demonstrates the potential additional value of ICG videoangiography including FLOW 800 analyses in the postoperative monitoring of transplanted flaps. © 2016 Wiley Periodicals, Inc. Microsurgery 37:235-242, 2017.

Cited by 25 publications

References 27 publications

A comparative analysis using flowmeter, laser-Doppler spectrophotometry, and indocyanine green-videoangiography for detection of vascular stenosis in free flaps

A comparative analysis using flowmeter, laser-Doppler spectrophotometry, and indocyanine green-videoangiography for detection of vascular stenosis in free flaps

Detection of thrombosis in microvessels with indocyanine green videoangiography

Effect of Segment Length and Number of Osteotomy Sites on Cancellous Bone Perfusion in Free Fibula Flaps

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Indocyanine green videoangiography‐assisted prediction of flap necrosis in the rat epigastric flap using the flow® 800 tool

Abstract: This demonstrates the potential additional value of ICG videoangiography including FLOW 800 analyses in the postoperative monitoring of transplanted flaps. © 2016 Wiley Periodicals, Inc. Microsurgery 37:235-242, 2017.

Cited by 25 publications

References 27 publications

A comparative analysis using flowmeter, laser-Doppler spectrophotometry, and indocyanine green-videoangiography for detection of vascular stenosis in free flaps

A comparative analysis using flowmeter, laser-Doppler spectrophotometry, and indocyanine green-videoangiography for detection of vascular stenosis in free flaps

Detection of thrombosis in microvessels with indocyanine green videoangiography

Effect of Segment Length and Number of Osteotomy Sites on Cancellous Bone Perfusion in Free Fibula Flaps

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Indocyanine green videoangiography‐assisted prediction of flap necrosis in the rat epigastric flap using the flow^® 800 tool