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

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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).

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吲哚菁绿荧光血管造影预测背阔肌游离皮瓣远端皮瓣坏死

背景背阔肌远端皮瓣的血管化决定了手术的成功，特别是在大的缺损中。由于远端皮瓣坏死导致的失败可能需要再次手术并增加死亡率。吲哚菁绿荧光血管造影（ICGFA）作为术中筋膜皮瓣灌注成像的一种方式，已经彻底改变了自由皮瓣手术。在肌瓣灌注评估中的应用证据尚缺乏。我们探讨ICGFA在预测大LD游离皮瓣远端坏死中的作用。方法回顾性记录我院2018年1月- 2022年12月收治的所有大面积游离皮瓣重建（表面积250 cm2）病例。根据术中灌注评估：ICGFA或临床判断对患者进行分组。主要结果是皮瓣远端坏死占皮瓣总坏死的5%。次要结果包括再手术和总手术时间。采用多变量分析确定独立的危险因素。结果共纳入107例患者，平均年龄57±18岁，BMI为29±6 kg/m2。36例（34%）患者行ICGFA。ICGFA与远端皮瓣坏死显著减少相关(18.3% vs. 2.8%, OR: - 0.15, 95% CI: - 0.29至- 0.02；p = 0.03)和再手术(40.8% vs. 19.4%, OR:−0.21,CI:−0.41 ~−0.02；P = 0.03)，无延长手术时间（158±63 vs 191±91 min, P = 0.39）。结论ICGFA可提高大瓣游离皮瓣重建的成功率，使血流灌注评估更加准确可靠。这突出了ICGFA作为临床标准的巨大潜力，超越了其仅在筋膜皮肤游离皮瓣手术中的应用，并展示了其在游离肌肉皮瓣手术中的有效性。注册：本研究已在https://www.researchregistry.com注册（识别号：researchregistry9496）。

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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.