Laser-Assisted Indocyanine Green Dye Angiography for Postoperative Fistulas After Salvage Laryngectomy

Partington, Erin J.; Moore, Lindsay; Kahmke, Russel; Warram, Jason M.; Carroll, William W.; Rosenthal, Eben L.; Greene, Bruce M.

doi:10.1001/jamaoto.2017.0187

Cited by 12 publications

(7 citation statements)

References 12 publications

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“…The reported post-laryngectomy pharyngocutaneous fistula rates range between 16% to 65% 22 . Two prospective studies including 37 and 41 patients respectively, compared mucosal perfusion detected by this technology in salvage laryngectomies and found that patients who developed postoperative fistulas had lower mucosal perfusion values when compared with patients who did not develop fistulas 12,23 , suggesting that there might be a role for LAIG in assessing vascularisation of the pharyngeal mucosa remnant. In the same line as these two last reports, we did not experience any pharyngocutaneous fistulas after pharyngectomies.…”

Section: Discussionmentioning

confidence: 99%

“…Areas of concern were considered poorly perfused if, at 45-60 seconds after injection and flush of the IG, the intensity of the site by LAIG was 33% or less of a well perfused area set as a control on the SPY software. This threshold value was determined following previous reports of the literature 11,12 . The poorly perfused area was marked and trimmed back to confirmed well perfused tissue.…”

Section: Laicg Dye Angiography Protocolmentioning

confidence: 99%

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Applications of intraoperative angiography in head and neck reconstruction

Sahovaler

Gualtieri

Lee

et al. 2021

Acta Otorhinolaryngol Ital

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Objective. Laser-assisted angiography with indocyanine green (LAIG) allows objective intraoperative evaluation of tissue vascularity. We endeavored to describe our experience with this technique in the head and neck region. Methods. A retrospective review from February 2016 till October 2018 was conducted. We included patients who underwent head and neck procedures in which LAIG was employed. The main outcome was postoperative wound complications. We analysed the influence of LAIG results in intraoperative decision-making process. Results. Nineteen patients were included, and follow-up was for at least 6 months. LAIG was employed in 11 local flaps, 9 free flaps and 6 cases of pharyngeal closure during total laryngectomies. Wound complications occurred in two cases with distal tip flap necrosis. LAIG findings resulted in changes in decision making intraoperatively in 84% of procedures, which consisted in trimming poorly perfused tissues. There were no pharyngocutaneous fistulas. Conclusions. This represents a descriptive report on the use of LAIG on diverse head and neck reconstruction cases, with important impact on the decision-making process. A low number of postoperative wound complications were observed. KEY WORDS: laser-assisted angiography head and neck cancer, skin necrosis, indocyanine green, SPY RIASSUNTO Obiettivi. La tecnica LAIG (Laser-assisted angiography with indocyanine green) permette una valutazione intraoperatoria della vascolarizzazione tissutale. Con questo studio vogliamo condividere la nostra esperienza con tale tecnica nel distretto testa collo. Metodi. È stata condotta un'analisi retrospettiva che include pazienti sottoposti a chirurgia del distretto testa-collo con utilizzo di LAIG intraoperatorio. È stata valutata l'incidenza di complicanze postoperatorie della ferita chirurgica e l'influenza dell'utilizzo di LAIG intraoperatorio nel processo decisionale del chirurgo. Risultati. Diciannove pazienti sono stati inclusi con follow-up minimo di 6 mesi. LAIG è stata applicata su 11 lembi locali, 9 lembi liberi ed in 6 casi di chiusura del faringe post laringectomia totale. In due casi la necrosi distale del lembo ha portato a complicanze correlate alla ferita chirurgica. LAIG ha portato a modificazione del processo decisionale intraoperatorio nell'84% dei casi. Conclusioni. Questo studio descrittivo dimostra la applicabilità di LAIG in diverse procedure ricostruttive nel distretto testa-collo, con un impatto importante sul processo decisionale intraoperatorio ed una bassa incidenza di complicanze della ferita chirurgica.

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Section: Discussionmentioning

confidence: 99%

Section: Laicg Dye Angiography Protocolmentioning

confidence: 99%

Applications of intraoperative angiography in head and neck reconstruction

Sahovaler

Gualtieri

Lee

et al. 2021

Acta Otorhinolaryngol Ital

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“…These include dye tests, videoflouroscopy, oral pharyngooesophageal scintigraphy, and laser-assisted indocyanine dye. [ 15 16 ]…”

Section: Discussionmentioning

confidence: 99%

Intraoperative dye test in total laryngectomy: A technique to reduce the incidence of pharyngocutaneous fistula

et al. 2020

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“…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.…”

Section: Icg Dosing In Head and Neck Reconstructionmentioning

confidence: 99%

“…13 Its pharmacokinetics, strict occupancy to the intravascular space, and short half-life of 2.5 to 4 minutes help in sequential monitoring of flap perfusion as needed. 12,14 Additionally, the binding of the ICG to the plasma proteins with no capillary leakage makes it a suitable tracer for assessing vascular perfusion. 15 It has been safely used to assess, liver, renal, and pancreas transplant, cardiac output, choroid, skin, and bone perfusion after maxillary osteotomies.…”

mentioning

confidence: 99%

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

2020

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Reconstructive procedures in the head and neck can be a surgical challenge owing to the complex anatomical and physiological structure. Different locoregional and microvascular flaps are used for various defects to improve both function and cosmesis. Subjective clinical findings have been the mainstay for perfusion monitoring; however, areas of borderline perfusion are much more difficult to assess clinically. Multiple technologies that offer objective perfusion assessment have been developed to improve surgical outcomes. Indocyanine green (ICG) angiography has gained popularity owing to its minimal invasiveness and increased sensitivity and specificity in assessing flap perfusion particularly in the head and neck. It has been extensively used in free flaps, pedicled flaps (including nasal reconstruction), facelift procedures, random flaps, skull base reconstruction, and pharyngocutaneous fistula prediction. Its perioperative use has provided valuable qualitative and quantitative data that aid our understanding of flap hemodynamics. Clinically, this impacted decision-making in flap design, harvest, inset, and precocious salvage interventions. Though increased cost and intraoperative time could be limitations, cost-effectiveness studies have supported its use, particularly in high-risk individuals. Limitations include the lack of standardized dosing and consistent methodology agreement for data analysis. Future studies should involve larger cohorts and multi-institute studies to overcome such limitations.

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Laser-Assisted Indocyanine Green Dye Angiography for Postoperative Fistulas After Salvage Laryngectomy

Abstract: Patients who developed postoperative fistulas had lower mucosal perfusion as detected by ICG dye angiography when compared with patients who did not develop fistulas.

Cited by 12 publications

References 12 publications

Applications of intraoperative angiography in head and neck reconstruction

Applications of intraoperative angiography in head and neck reconstruction

Intraoperative dye test in total laryngectomy: A technique to reduce the incidence of pharyngocutaneous fistula

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

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