RSS-Feed abonnieren
DOI: 10.1055/s-0040-1721113
The Use of Indocyanine Green Angiography for Cosmetic and Reconstructive Assessment in the Head and Neck
![](https://www.thieme-connect.de/media/fps/202006/lookinside/thumbnails/10-1055-s-0040-1721113_200151oa-1.jpg)
Abstract
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.
Keywords
indocyanine green - fluorescence - angiography - head and neck - reconstruction - free flap - facelift - nasal reconstruction - facial plastic surgeryPublikationsverlauf
Artikel online veröffentlicht:
24. Dezember 2020
© 2020. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Abdelwahab M, Kandathil CK, Most SP, Spataro EA. Utility of indocyanine green angiography to identify clinical factors associated with perfusion of paramedian forehead flaps during nasal reconstruction surgery. JAMA Facial Plast Surg 2019; 21 (03) 206-212
- 2 Devine JC, Potter LA, Magennis P, Brown JS, Vaughan ED. Flap monitoring after head and neck reconstruction: evaluating an observation protocol. J Wound Care 2001; 10 (01) 525-529
- 3 Betz CS, Zhorzel S, Schachenmayr H. et al. Endoscopic measurements of free-flap perfusion in the head and neck region using red-excited Indocyanine Green: preliminary results. J Plast Reconstr Aesthet Surg 2009; 62 (12) 1602-1608
- 4 Pawar SS, Kim MM. Updates in forehead flap reconstruction of facial defects. Curr Opin Otolaryngol Head Neck Surg 2013; 21 (04) 384-388
- 5 Hölzle F, Loeffelbein DJ, Nolte D, Wolff KD. Free flap monitoring using simultaneous non-invasive laser Doppler flowmetry and tissue spectrophotometry. J Craniomaxillofac Surg 2006; 34 (01) 25-33
- 6 VIOPTIX. Available at: https://www.vioptix.com/. Accessed on December 2, 2020
- 7 Eskiizmir G, Tanyeri Toker G, Ozgur E, Tarhan S, Cengiz Ozyurt B. Hemodynamic changes in paramedian forehead flap. J Craniofac Surg 2018; 29 (01) 159-162
- 8 de Weerd L, Mercer JB, Setså LB. Intraoperative dynamic infrared thermography and free-flap surgery. Ann Plast Surg 2006; 57 (03) 279-284
- 9 Singer R, Lewis CM, Franklin JD, Lynch JB. Fluorescein test for prediction of flap viability during breast reconstructions. Plast Reconstr Surg 1978; 61 (03) 371-375
- 10 Woodard CR, Most SP. Intraoperative angiography using laser-assisted indocyanine green imaging to map perfusion of forehead flaps. Arch Facial Plast Surg 2012; 14 (04) 263-269
- 11 Holm C, Mayr M, Höfter E, Dornseifer U, Ninkovic M. Assessment of the patency of microvascular anastomoses using microscope-integrated near-infrared angiography: a preliminary study. Microsurgery 2009; 29 (07) 509-514
- 12 Holm C, Mayr M, Höfter E, Becker A, Pfeiffer UJ, Mühlbauer W. Intraoperative evaluation of skin-flap viability using laser-induced fluorescence of indocyanine green. Br J Plast Surg 2002; 55 (08) 635-644
- 13 Still J, Law E, Dawson J, Bracci S, Island T, Holtz J. Evaluation of the circulation of reconstructive flaps using laser-induced fluorescence of indocyanine green. Ann Plast Surg 1999; 42 (03) 266-274
- 14 Partington EJ, Moore LS, Kahmke R. et al. Laser-assisted indocyanine green dye angiography for postoperative fistulas after salvage laryngectomy. JAMA Otolaryngol Head Neck Surg 2017; 143 (08) 775-781
- 15 Ishihara H, Otomo N, Suzuki A, Takamura K, Tsubo T, Matsuki A. Detection of capillary protein leakage by glucose and indocyanine green dilutions during the early post-burn period. Burns 1998; 24 (06) 525-531
- 16 Salman S, Fattahi T, Fernandes R, Steinberg B. Dynamic analysis of maxillary perfusion during Le Fort I osteotomy using indocyanine green. Int J Oral Maxillofac Surg 2018; 47 (10) 1311-1315
- 17 Ott P. Hepatic elimination of indocyanine green with special reference to distribution kinetics and the influence of plasma protein binding. Pharmacol Toxicol 1998; 83 (Suppl. 02) 1-48
- 18 Wood EH. Diagnostic applications of indicator-dilution technics in congenital heart disease. Circ Res 1962; 10: 531-568
- 19 Zenn MR. Fluorescent angiography. Clin Plast Surg 2011; 38 (02) 293-300
- 20 Surowitz JB, Most SP. Use of laser-assisted indocyanine green angiography for early division of the forehead flap pedicle. JAMA Facial Plast Surg 2015; 17 (03) 209-214
- 21 Hoesli R, Brennan JR, Rosko AJ. et al. Intraoperative fluorescent angiography predicts pharyngocutaneous fistula after salvage laryngectomy. Ann Surg Oncol 2019; 26 (05) 1320-1325
- 22 Suzuki Y, Shimizu Y, Kasai S. et al. Indocyanine green fluorescence videoangiography for reliable variations of supraclavicular artery flaps. Arch Plast Surg 2019; 46 (04) 318-323
- 23 Miyazaki H, Igari K, Kudo T. et al. Significance of the lateral thoracic artery in pectoralis major musculocutaneous flap reconstruction: quantitative assessment of blood circulation using indocyanine green angiography. Ann Plast Surg 2017; 79 (05) 498-504
- 24 Preidl RHM, Schlittenbauer T, Weber M, Neukam FW, Wehrhan F. Assessment of free microvascular flap perfusion by intraoperative fluorescence angiography in craniomaxillofacial surgery. J Craniomaxillofac Surg 2015; 43 (05) 643-648
- 25 Abdelwahab M, Spataro EA, Kandathil CK, Most SP. Neovascularization perfusion of melolabial flaps using intraoperative indocyanine green angiography. JAMA Facial Plast Surg 2019; 21 (03) 230-236
- 26 Rudy SF, Abdelwahab M, Kandathil CK, Most SP. Paramedian forehead flap pedicle division after 7 days using laser-assisted indocyanine green angiography. J Plast Reconstr Aesthet Surg 2020; (e-pub ahead of print) DOI: 10.1016/j.bjps.2020.05.079.
- 27 Murono S, Ishikawa N, Ohtake H. et al. Intraoperative free jejunum flap monitoring with indocyanine green near-infrared angiography. Eur Arch Otorhinolaryngol 2014; 271 (05) 1335-1338
- 28 Yoshimatsu H, Yamamoto T, Iida T. Indocyanine green angiography for prediction of thrombosis in the internal jugular vein. Microsurgery 2015; 35 (06) 469-473
- 29 Swanson E. Evaluation of face lift skin perfusion and epinephrine effect using laser fluorescence imaging. Plast Reconstr Surg Glob Open 2015; 3 (08) e484
- 30 Taylor SR, Jorgensen JB. Use of fluorescent angiography to assess donor site perfusion prior to free tissue transfer. Laryngoscope 2015; 125 (06) E192-E197
- 31 Sacks JM, Nguyen AT, Broyles JM, Yu P, Valerio IL, Baumann DP. Near-infrared laser-assisted indocyanine green imaging for optimizing the design of the anterolateral thigh flap. Eplasty 2012; 12: e30
- 32 Geltzeiler M, Nakassa ACI, Turner M. et al. Evaluation of intranasal flap perfusion by intraoperative indocyanine green fluorescence angiography. Oper Neurosurg (Hagerstown) 2018; 15 (06) 672-676
- 33 Kerr EE, Jamshidi A, Carrau RL. et al. Indocyanine green fluorescence to evaluate nasoseptal flap viability in endoscopic endonasal cranial base surgery. J Neurol Surg, B Skull Base 2017; 78 (05) 408-412
- 34 Disa JJ, Cordeiro PG, Hidalgo DA. Efficacy of conventional monitoring techniques in free tissue transfer: an 11-year experience in 750 consecutive cases. Plast Reconstr Surg 1999; 104 (01) 97-101
- 35 Haughey BH, Wilson E, Kluwe L. et al. Free flap reconstruction of the head and neck: analysis of 241 cases. Otolaryngol Head Neck Surg 2001; 125 (01) 10-17
- 36 Bui DT, Cordeiro PG, Hu QY, Disa JJ, Pusic A, Mehrara BJ. Free flap reexploration: indications, treatment, and outcomes in 1193 free flaps. Plast Reconstr Surg 2007; 119 (07) 2092-2100
- 37 Holm C, Tegeler J, Mayr M, Becker A, Pfeiffer UJ, Mühlbauer W. Monitoring free flaps using laser-induced fluorescence of indocyanine green: a preliminary experience. Microsurgery 2002; 22 (07) 278-287
- 38 Green III JM, Thomas S, Sabino J. et al. Use of intraoperative fluorescent angiography to assess and optimize free tissue transfer in head and neck reconstruction. J Oral Maxillofac Surg 2013; 71 (08) 1439-1449
- 39 Moris V, Cristofari S, Stivala A. et al. Fluorescent indocyanine green angiography: Preliminary results in microsurgery monitoring. J Stomatol Oral Maxillofac Surg 2019; 120 (04) 297-300
- 40 Bigdeli AK, Thomas B, Falkner F, Gazyakan E, Hirche C, Kneser U. The impact of indocyanine-green fluorescence angiography on intraoperative decision-making and postoperative outcome in free flap surgery. J Reconstr Microsurg 2020; (e-pub ahead of print) DOI: 10.1055/s-0040-1710552.
- 41 Benatar MJ, Dassonville O, Chamorey E. et al. Impact of preoperative radiotherapy on head and neck free flap reconstruction: a report on 429 cases. J Plast Reconstr Aesthet Surg 2013; 66 (04) 478-482
- 42 Bozikov K, Arnez ZM. Factors predicting free flap complications in head and neck reconstruction. J Plast Reconstr Aesthet Surg 2006; 59 (07) 737-742
- 43 Tanaka K, Okazaki M, Homma T, Yano T, Mori H. Bilateral inferior alveolar nerve reconstruction with a vascularized sural nerve graft included in a free fibular osteocutaneous flap after segmental mandibulectomy. Head Neck 2016; 38 (05) E111-E114
- 44 Lee LN, Smith DF, Boahene KD, Byrne PJ. Intraoperative laser-assisted indocyanine green imaging for objective measurement of the vascular delay technique in locoregional head and neck flaps. JAMA Facial Plast Surg 2014; 16 (05) 343-347
- 45 Makiguchi T, Yokoo S, Miyazaki H. et al. Supercharged pectoralis major musculocutaneous flap. J Craniofac Surg 2013; 24 (02) e179-e182
- 46 Giunta RE, Holzbach T, Taskov C. et al. Prediction of flap necrosis with laser induced indocyanine green fluorescence in a rat model. Br J Plast Surg 2005; 58 (05) 695-701
- 47 Christensen JM, Baumann DP, Myers JN, Buretta K, Sacks JM. Indocyanine green near-infrared laser angiography predicts timing for the division of a forehead flap. Eplasty 2012; 12: e41
- 48 Shah A, Au A. CASE REPORT Laser-assisted indocyanine green evaluation of paramedian forehead flap perfusion prior to pedicle division. Eplasty 2013; 13: e8
- 49 Calloway HE, Moubayed SP, Most SP. Cost-effectiveness of early division of the forehead flap pedicle. JAMA Facial Plast Surg 2017; 19 (05) 418-420
- 50 Shaye DA, Tollefson TT. What is the optimal timing for dividing a forehead flap?. Laryngoscope 2020; (e-pub ahead of print) DOI: 10.1002/lary.28588.
- 51 Kislevitz ML, Lu KB, Sanniec K, Amirlak B. Unique uses of SPY: high-risk facelift. Plast Reconstr Surg Glob Open 2019; 7 (06) e2183
- 52 Dunlevy TM, O'Malley TP, Postma GN. Optimal concentration of epinephrine for vasoconstriction in neck surgery. Laryngoscope 1996; 106 (11) 1412-1414
- 53 Siegel RJ, Vistnes LM. Epinephrine requirements for effective hemostasis in local anesthetics. Surg Forum 1972; 23 (00) 514-516
- 54 Kwon JG, Choi YJ, Kim SC, Hong JP, Jeong WS, Oh TS. A technique for safe deep facial tissue dissection: indocyanine green-assisted intraoperative real-time visualization of the vasa nervorum of facial nerve with a near-infrared camera. J Craniomaxillofac Surg 2019; 47 (11) 1819-1826
- 55 Qureshi SS, Chaturvedi P, Pai PS. et al. A prospective study of pharyngocutaneous fistulas following total laryngectomy. J Cancer Res Ther 2005; 1 (01) 51-56
- 56 Dedivitis RA, Ribeiro KC, Castro MA, Nascimento PC. Pharyngocutaneous fistula following total laryngectomy. Acta Otorhinolaryngol Ital 2007; 27 (01) 2-5
- 57 Mücke T, Rau A, Merezas A. et al. Identification of perioperative risk factor by laser-Doppler spectroscopy after free flap perfusion in the head and neck: a prospective clinical study. Microsurgery 2014; 34 (05) 345-351
- 58 Heitland AS, Markowicz MP, Koellensperger E, Schoth F, Pallua N. Early and long-term evaluation of perfusion changes in free DIEP-flaps for breast reconstruction via IC-view and duplex ultrasound: autonomous or peripheral perfusion?. J Reconstr Microsurg 2009; 25 (02) 139-145
- 59 Tremblay PL, Hudon V, Berthod F, Germain L, Auger FA. Inosculation of tissue-engineered capillaries with the host's vasculature in a reconstructed skin transplanted on mice. Am J Transplant 2005; 5 (05) 1002-1010
- 60 Pohlenz P, Klatt J, Schön G, Blessmann M, Li L, Schmelzle R. Microvascular free flaps in head and neck surgery: complications and outcome of 1000 flaps. Int J Oral Maxillofac Surg 2012; 41 (06) 739-743
- 61 Holm C, Dornseifer U, Sturtz G, Basso G, Schuster T, Ninkovic M. The intrinsic transit time of free microvascular flaps: clinical and prognostic implications. Microsurgery 2010; 30 (02) 91-96