Document Detail


Quantitative assessment of perfusion and vascular compromise in perforator flaps using a near-infrared fluorescence-guided imaging system.
MedLine Citation:
PMID:  19644259     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Techniques currently used to determine flap perfusion are mainly subjective, with the majority of reconstructive surgeons still relying on clinical examination. In this study, the authors demonstrate the use of near-infrared fluorescence angiography to directly quantify normal and abnormal perfusion in perforator flaps.
METHODS: Indocyanine green was injected intravenously into anesthetized adult pigs (n = 38). A custom near-infrared fluorescence imaging system was used for image acquisition and quantitation. Thirty-nine flaps were designed based on identified perforators, and postoperative imaging was performed for comparison. In select flaps, isolated occlusion of the arterial and venous pedicle was performed. In select flaps, vascular spasm was induced by local irrigation of the vessels with epinephrine. The fluorescence intensities of select regions of interest were quantified. From these data, the authors defined two indices for abnormal perfusion: the Tmax ratio and the drainage ratio.
RESULTS: The authors identified a normal pattern of perfusion before flap elevation, composed of a distinct fluorescence intensity peak at maximal arterial inflow followed by a smooth drop representing venous drainage. Delay of this peak after flap elevation, as indicated by the Tmax ratio, identified vascular spasm and arterial occlusion (p < 0.0001). Abnormal fall of fluorescence intensities after this peak, as indicated by the drainage ratio, identified venous occlusion (p < 0.0001).
CONCLUSIONS: Quantitation of fluorescence intensities by near-infrared angiography accurately characterizes arterial and venous compromise. The authors' technique can assess perfusion characteristics during the intraoperative and postoperative periods and therefore complements clinically based subjective criteria now used for flap assessment.
Authors:
Aya Matsui; Bernard T Lee; Joshua H Winer; Rita G Laurence; John V Frangioni
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Plastic and reconstructive surgery     Volume:  124     ISSN:  1529-4242     ISO Abbreviation:  Plast. Reconstr. Surg.     Publication Date:  2009 Aug 
Date Detail:
Created Date:  2009-07-31     Completed Date:  2009-09-22     Revised Date:  2014-10-13    
Medline Journal Info:
Nlm Unique ID:  1306050     Medline TA:  Plast Reconstr Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  451-60     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Algorithms
Animals
Coloring Agents / diagnostic use
Female
Fluorescein Angiography* / methods
Image Processing, Computer-Assisted
Indocyanine Green / diagnostic use
Surgical Flaps / blood supply*
Swine
Grant Support
ID/Acronym/Agency:
R01 CA115296/CA/NCI NIH HHS; R01 CA115296-04/CA/NCI NIH HHS; R01 CA115296-05/CA/NCI NIH HHS; R01 EB005805/EB/NIBIB NIH HHS; R01 EB005805-03/EB/NIBIB NIH HHS; R01-CA-115296/CA/NCI NIH HHS; R01-EB-005805/EB/NIBIB NIH HHS
Chemical
Reg. No./Substance:
0/Coloring Agents; IX6J1063HV/Indocyanine Green
Comments/Corrections

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