Indocyanine Green Fluorescence Angiography as a Predictor of Distal Flap Necrosis in Latissimus Dorsi Free Flaps

IF 1.5 3区医学 Q3 SURGERY

Microsurgery Pub Date : 2025-02-18 DOI:10.1002/micr.70019

Oliver Didzun, Benjamin Thomas, Adriana C. Panayi, Sonja Broichhausen, Sophie Osenegg, Florian Falkner, Gabriel Hundeshagen, Samuel Knoedler, Leonard Knoedler, Felix Vollbach, Ulrich Kneser, Emre Gazyakan, Amir K. Bigdeli

{"title":"Indocyanine Green Fluorescence Angiography as a Predictor of Distal Flap Necrosis in Latissimus Dorsi Free Flaps","authors":"Oliver Didzun, Benjamin Thomas, Adriana C. Panayi, Sonja Broichhausen, Sophie Osenegg, Florian Falkner, Gabriel Hundeshagen, Samuel Knoedler, Leonard Knoedler, Felix Vollbach, Ulrich Kneser, Emre Gazyakan, Amir K. Bigdeli","doi":"10.1002/micr.70019","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Vascularization of the distal latissimus dorsi (LD) muscle flap determines the success of the procedure, particularly in large defects. Failure due to distal flap necrosis can necessitate reoperation and increase mortality. Indocyanine green fluorescence angiography (ICGFA), as a modality that allows for intraoperative imaging of <i>fasciocutaneous</i> flap perfusion, has revolutionized free flap surgery. Evidence of use in muscle flap perfusion assessment is lacking. We investigate the efficacy of ICGFA in predicting distal flap necrosis in large LD free flaps.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>We prospectively recorded all cases of large LD free flap reconstruction (surface area > 250 cm<sup>2</sup>) at our institution (01/2018–12/2022). Patients were grouped according to the intraoperative perfusion assessment: ICGFA or clinical judgment. The primary outcome was distal flap necrosis > 5% of the total flap. Secondary outcomes included reoperation and total operation time. Multivariable analyses were applied to identify independent risk factors.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>A total of 107 patients with mean age of 57 ± 18 years and BMI of 29 ± 6 kg/m<sup>2</sup> were included. Thirty-six patients (34%) underwent ICGFA. ICGFA was associated with a significant reduction in distal flap necrosis (18.3% vs. 2.8%, OR: −0.15, 95% CI: −0.29 to −0.02; <i>p</i> = 0.03) and reoperation (40.8% vs. 19.4%, OR: −0.21, CI: −0.41 to −0.02; <i>p</i> = 0.03), with no prolongation of the operation time (158 ± 63 vs. 191 ± 91 min, <i>p</i> = 0.39).</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>ICGFA is associated with increased success of large LD free flap reconstruction, allowing a more accurate and reliable assessment of perfusion. This highlights the immense potential of ICGFA as a clinical standard, surpassing its application solely in fasciocutaneous free flap surgery and, showcasing its efficacy in free muscle flap procedures.</p>\n \n <p><b>Registration:</b> This study has been registered at https://www.researchregistry.com (identification number: researchregistry9496).</p>\n </section>\n </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 2","pages":""},"PeriodicalIF":1.5000,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Microsurgery","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/micr.70019","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"SURGERY","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Vascularization of the distal latissimus dorsi (LD) muscle flap determines the success of the procedure, particularly in large defects. Failure due to distal flap necrosis can necessitate reoperation and increase mortality. Indocyanine green fluorescence angiography (ICGFA), as a modality that allows for intraoperative imaging of fasciocutaneous flap perfusion, has revolutionized free flap surgery. Evidence of use in muscle flap perfusion assessment is lacking. We investigate the efficacy of ICGFA in predicting distal flap necrosis in large LD free flaps.

Methods

We prospectively recorded all cases of large LD free flap reconstruction (surface area > 250 cm²) at our institution (01/2018–12/2022). Patients were grouped according to the intraoperative perfusion assessment: ICGFA or clinical judgment. The primary outcome was distal flap necrosis > 5% of the total flap. Secondary outcomes included reoperation and total operation time. Multivariable analyses were applied to identify independent risk factors.

Results

A total of 107 patients with mean age of 57 ± 18 years and BMI of 29 ± 6 kg/m² were included. Thirty-six patients (34%) underwent ICGFA. ICGFA was associated with a significant reduction in distal flap necrosis (18.3% vs. 2.8%, OR: −0.15, 95% CI: −0.29 to −0.02; p = 0.03) and reoperation (40.8% vs. 19.4%, OR: −0.21, CI: −0.41 to −0.02; p = 0.03), with no prolongation of the operation time (158 ± 63 vs. 191 ± 91 min, p = 0.39).

Conclusion

ICGFA is associated with increased success of large LD free flap reconstruction, allowing a more accurate and reliable assessment of perfusion. This highlights the immense potential of ICGFA as a clinical standard, surpassing its application solely in fasciocutaneous free flap surgery and, showcasing its efficacy in free muscle flap procedures.

Registration: This study has been registered at https://www.researchregistry.com (identification number: researchregistry9496).

查看原文本刊更多论文

求助全文

约1分钟内获得全文求助全文

来源期刊

Microsurgery 医学-外科

CiteScore

3.80

自引率

19.00%

发文量

128

审稿时长

4-8 weeks

期刊介绍： Microsurgery is an international and interdisciplinary publication of original contributions concerning surgery under microscopic magnification. Microsurgery publishes clinical studies, research papers, invited articles, relevant reviews, and other scholarly works from all related fields including orthopaedic surgery, otolaryngology, pediatric surgery, plastic surgery, urology, and vascular surgery.