Benedikt Schäfer, Gerrit Freund, Jonah Orr, Kay Nolte, Joachim Weis, Jörg Bahm, Justus P Beier
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引用次数: 0
Abstract
Peripheral nerve surgery, particularly in cases of nerve compression syndrome (NCS), necessitates a comprehensive evaluation of intraneural blood flow, as localized reductions in nerve perfusion are integral to the etiopathogenesis of such conditions. Although nerve perfusion is currently guided by morphologic characteristics, this assessment is subjective and prone to bias. Intraoperative fluorescence-assisted perfusion imaging with indocyanine green (ICG) is an established tool in flap and lymphatic surgery to objectively assess perfusion intraoperatively. However, only a few unspecific applications of ICG in peripheral nerve surgery have been published so far. In this study, we performed intraoperative perfusion imaging using ICG in 16 consecutive operations within the peripheral nervous system, including microsurgical reconstructions after obstetric brachial plexus injury, decompression for NCS, and vascularized ulnar nerve interposition transfers. Our findings show the utility of ICG in delineating healthy perfusion borders at proximal and distal stump levels after neuroma resection, and we demonstrate a correlation between histological findings and these clinically observed perfusion patterns. In NCS cases, we demonstrate that ICG imaging is effective in highlighting reduced perfusion predecompression and improved perfusion postdecompression. Additionally, ICG proved valuable for assessing perfusion of free vascularized nerve grafts. Intraoperative ICG perfusion imaging is a valuable tool during surgery of the peripheral nervous system, providing insights into the etiopathogenesis of NCS and aiding in the visualization of perfusion. This study underscores the potential of ICG in nerve surgery and its applicability for improving surgical outcomes and advancing our understanding of peripheral nerve pathologies.
期刊介绍:
Plastic and Reconstructive Surgery—Global Open is an open access, peer reviewed, international journal focusing on global plastic and reconstructive surgery.Plastic and Reconstructive Surgery—Global Open publishes on all areas of plastic and reconstructive surgery, including basic science/experimental studies pertinent to the field and also clinical articles on such topics as: breast reconstruction, head and neck surgery, pediatric and craniofacial surgery, hand and microsurgery, wound healing, and cosmetic and aesthetic surgery. Clinical studies, experimental articles, ideas and innovations, and techniques and case reports are all welcome article types. Manuscript submission is open to all surgeons, researchers, and other health care providers world-wide who wish to communicate their research results on topics related to plastic and reconstructive surgery. Furthermore, Plastic and Reconstructive Surgery—Global Open, a complimentary journal to Plastic and Reconstructive Surgery, provides an open access venue for the publication of those research studies sponsored by private and public funding agencies that require open access publication of study results. Its mission is to disseminate high quality, peer reviewed research in plastic and reconstructive surgery to the widest possible global audience, through an open access platform. As an open access journal, Plastic and Reconstructive Surgery—Global Open offers its content for free to any viewer. Authors of articles retain their copyright to the materials published. Additionally, Plastic and Reconstructive Surgery—Global Open provides rapid review and publication of accepted papers.