Evaluating the potential of quantitative assessment of intraoperative fasciocutaneous flap perfusion using microscope-integrated indocyanine green fluorescence angiography

IF 1.8 Q3 SURGERY

JPRAS Open Pub Date : 2026-03-01 Epub Date: 2026-01-16 DOI:10.1016/j.jpra.2026.01.008

Lasse W.P. van ’t Hof , David J. Nijssen , Richard M. van den Elzen , Joost R. van der Vorst , Roel Hompes , Mark-Bram Bouman , Mark I. van Berge Henegouwen , Matthijs Botman , Caroline Driessen

{"title":"Evaluating the potential of quantitative assessment of intraoperative fasciocutaneous flap perfusion using microscope-integrated indocyanine green fluorescence angiography","authors":"Lasse W.P. van ’t Hof , David J. Nijssen , Richard M. van den Elzen , Joost R. van der Vorst , Roel Hompes , Mark-Bram Bouman , Mark I. van Berge Henegouwen , Matthijs Botman , Caroline Driessen","doi":"10.1016/j.jpra.2026.01.008","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Perfusion-related complications are a leading cause of morbidity and flap loss in reconstructive surgery. While indocyanine green fluorescence angiography (ICG-FA) is commonly used, its subjective interpretation may miss early signs of perfusion disturbances. Quantitative ICG-FA (Q-ICG-FA) offers a more objective method, but its potential in fasciocutaneous flaps remains insufficiently studied.</div></div><div><h3>Methods</h3><div>This retrospective study analyzed intraoperative ICG-FA data from patients undergoing fasciocutaneous flap reconstruction. Fluorescence-time curves (FTCs) were generated from three regions of interest (ROIs): reference tissue (ROI1), proximal flap (ROI2), and distal flap (ROI3). FTCs and derived quantitative parameters, including time-to-peak (Ttp) and normalized inflow/outflow slopes, were compared between patients with (PRC) and without (No PRC) perfusion-related complications.</div></div><div><h3>Results</h3><div>Twenty patients were included. Seven patients experienced a perfusion-related complication, most commonly venous congestion (<em>n</em> = 5). FTCs of compromised flaps showed delayed fluorescence peaks and reduced washout, most pronounced in ROI3. Quantitatively, the PRC group showed prolonged Ttp in ROI2 (105 vs. 36 s, <em>p</em> = 0.013) and ROI3 (209 vs. 48 s, <em>p</em> = 0.001), lower normalized mean inflow slopes in ROI2 (2.4 vs 0.9%/s, <em>p</em> = 0.029) and ROI3 (4.2 vs. 1.6%/s, <em>p</em> = 0.002), and reduced mean outflow slopes in ROI3 (0.1 vs. 0.2, <em>p</em> = 0.021). Conventional clinical assessments failed to identify all compromised flaps.</div></div><div><h3>Conclusion</h3><div>Q-ICG-FA objectively distinguished flaps with and without perfusion-related complications. Dynamic parameters, particularly Ttp and inflow/outflow slopes, were most associated with perfusion compromise. Larger studies are needed to validate these findings.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"48 ","pages":"Pages 788-800"},"PeriodicalIF":1.8000,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"JPRAS Open","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2352587826000239","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/1/16 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"SURGERY","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Perfusion-related complications are a leading cause of morbidity and flap loss in reconstructive surgery. While indocyanine green fluorescence angiography (ICG-FA) is commonly used, its subjective interpretation may miss early signs of perfusion disturbances. Quantitative ICG-FA (Q-ICG-FA) offers a more objective method, but its potential in fasciocutaneous flaps remains insufficiently studied.

Methods

This retrospective study analyzed intraoperative ICG-FA data from patients undergoing fasciocutaneous flap reconstruction. Fluorescence-time curves (FTCs) were generated from three regions of interest (ROIs): reference tissue (ROI1), proximal flap (ROI2), and distal flap (ROI3). FTCs and derived quantitative parameters, including time-to-peak (Ttp) and normalized inflow/outflow slopes, were compared between patients with (PRC) and without (No PRC) perfusion-related complications.

Results

Twenty patients were included. Seven patients experienced a perfusion-related complication, most commonly venous congestion (n = 5). FTCs of compromised flaps showed delayed fluorescence peaks and reduced washout, most pronounced in ROI3. Quantitatively, the PRC group showed prolonged Ttp in ROI2 (105 vs. 36 s, p = 0.013) and ROI3 (209 vs. 48 s, p = 0.001), lower normalized mean inflow slopes in ROI2 (2.4 vs 0.9%/s, p = 0.029) and ROI3 (4.2 vs. 1.6%/s, p = 0.002), and reduced mean outflow slopes in ROI3 (0.1 vs. 0.2, p = 0.021). Conventional clinical assessments failed to identify all compromised flaps.

Conclusion

Q-ICG-FA objectively distinguished flaps with and without perfusion-related complications. Dynamic parameters, particularly Ttp and inflow/outflow slopes, were most associated with perfusion compromise. Larger studies are needed to validate these findings.

查看原文本刊更多论文

应用显微整合吲哚菁绿荧光血管造影评价术中筋膜皮瓣灌注定量评价的潜力

背景：灌注相关并发症是重建手术中并发症和皮瓣丢失的主要原因。虽然常使用吲哚菁绿荧光血管造影（ICG-FA），但其主观解释可能会遗漏灌注紊乱的早期迹象。定量ICG-FA （Q-ICG-FA）提供了一种更客观的方法，但其在筋膜皮瓣中的潜力仍未得到充分研究。方法回顾性分析行筋膜皮瓣重建术患者的术中心电图- fa数据。荧光时间曲线（FTCs）由三个感兴趣区域（roi）生成：参考组织（ROI1），近端皮瓣（ROI2）和远端皮瓣（ROI3）。比较有（PRC）和无（No PRC）灌注相关并发症患者的FTCs和衍生的定量参数，包括峰值时间（Ttp）和归一化流入/流出斜率。结果共纳入20例患者。7例患者出现灌注相关并发症，最常见的是静脉充血（n = 5）。受损皮瓣的FTCs显示延迟的荧光峰和减少的冲洗，在ROI3中最明显。从数量上看，PRC组ROI2（105比36秒，p = 0.013）和ROI3（209比48秒，p = 0.001）的Ttp延长，ROI2（2.4比0.9%/s, p = 0.029）和ROI3（4.2比1.6%/s, p = 0.002）的归一化平均流入斜率降低，ROI3的平均流出斜率降低（0.1比0.2,p = 0.021）。常规的临床评估无法识别所有受损皮瓣。结论q - icg - fa能客观区分皮瓣有无灌注相关并发症。动态参数，特别是Ttp和流入/流出斜率，与灌注损害最相关。需要更大规模的研究来验证这些发现。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

JPRAS Open Medicine-Surgery

CiteScore

1.60

自引率

0.00%

发文量

审稿时长

22 weeks

期刊介绍： JPRAS Open is an international, open access journal dedicated to publishing case reports, short communications, and full-length articles. JPRAS Open will provide the most current source of information and references in plastic, reconstructive & aesthetic surgery. The Journal is based on the continued need to improve surgical care by providing highlights in general reconstructive surgery; cleft lip, palate and craniofacial surgery; head and neck surgery; skin cancer; breast surgery; hand surgery; lower limb trauma; burns; and aesthetic surgery. The Journal will provide authors with fast publication times.