Real-time indocyanine green angiography optimises anterolateral thigh flap reconstruction in oral and maxillofacial defects: a prospective clinical study.

This study aimed to evaluate the clinical efficacy of indocyanine green angiography (ICGA) in optimising anterolateral thigh (ALT) flap reconstruction for oral and maxillofacial defects. Fifteen consecutive patients (10 males, mean (SD) age 53.8 (14.5) years) undergoing ALT flap reconstruction following tumour resection were prospectively enrolled. Intravenous indocyanine green (ICG) (2.5 mg/ml) administration combined with hand-held Doppler ultrasound (DUS) enabled preoperative mapping of the descending branch of the lateral circumflex femoral artery and localisation of the perforator. Intraoperative real-time ICGA guidance facilitated precise flap trimming, while postoperative monitoring incorporated both DUS and ICGA assessments. Preoperative imaging revealed comparable perforator detection rates between modalities (DUS: 35/42 confirmed vs ICGA: 33/39 confirmed; accuracy 83.3% vs 84.6%, Z = 0.096, p = 0.081, kappa = 0.82, p = 0.026). ICGA-guided intraoperative modifications proved critical in seven cases, all achieving marginal flap viability. Four high-risk patients avoided reoperation through ICGA-guided perfusion monitoring. Notably, ICGA detected salvageable perfusion in two cases with absent DUS signals, and confirmed arterial patency following re-anastomosis in one case. ICGA enhances surgical precision in ALT flap reconstruction through perfusion mapping, enabling real-time intraoperative decision-making and improved postoperative monitoring sensitivity.