Efficacy of indocyanine green fluorescence angiography in improving the reliability of pedicled flaps in head and neck reconstruction

Pedicled flaps are frequently used for reconstructing the head and neck area. Partial or complete loss can be debilitating, affecting speech, swallowing, and appearance. This is a prospective interventional study conducted in head and neck cancer patients undergoing reconstruction with pedicled flaps from August 2022 to May 2023, where the Indocyanine green–fluorescence angiography (ICG-FA) technique was employed to improve the outcomes of flap surgery. Retrospective data of pedicled flaps performed from 2021 to June 2022 were collected from medical records to compare outcomes with the prospective group. Demographics, surgery details, and flap outcomes were obtained for both groups. Data from 46 patients in the prospective group and 77 patients in the retrospective group were analyzed. Each group was further categorized into laryngeal and non-laryngeal subgroups. Distribution of age, sex, history of prior surgery, and previous radiotherapy was similar between the two groups.

In the non-laryngeal group, the prospective intervention arm versus the retrospective arm had partial flap loss in 5.6% versus 22.9%. The occurrence of flap loss (partial/total) was significantly lower in the prospective group within the non-laryngeal subgroup (p=0.025). In the laryngeal subgroup, salivary leaks were used as a proxy for outcome, and there was no significant difference between both the groups (p=1.00). The prospective group experienced fewer secondary procedures, second flap surgeries, though these differences did not reach statistical significance.

ICG-FA appears to be a valuable tool for assessing flap perfusion. Further research is essential to obtain objective measures of perfusion and to apply ICG-FA in specific cases to enhance cost-effectiveness.