title: Image-guided perforator flap design using invisible near-infrared light and validation with x-ray angiography.
abstract: Although perforator flaps mark an important conceptual change in reconstructive surgery, individual perforator vessels show a high degree of variability with respect to anatomic landmarks. We have developed an intraoperative imaging system that simultaneously displays surgical anatomy and otherwise invisible near-infrared images. In 22 adult pigs, perforating vessels were identified within seconds using this optical imaging system and systemic injection of indocyanine green. Perforator flaps were then designed based on these results, and vessel location confirmed by direct visualization and anatomic dissection. Since x-ray angiography remains the gold standard for identification of underlying vessels, conventional x-ray angiography was also performed in 8 pigs to verify the location of perforators. There was full correlation of all the perforators identified among near-infrared fluorescence angiography, x-ray angiography, and anatomic dissection. The technology we describe provides high-sensitivity real-time image guidance throughout perforator dissection, and permits patient-specific flap design.
authors.affiliation: Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
authors.forename: Aya
authors.initials: A
authors.lastname: Matsui
authors.forename: Bernard T
authors.initials: BT
authors.lastname: Lee
authors.forename: Joshua H
authors.initials: JH
authors.lastname: Winer
authors.forename: Vida
authors.initials: V
authors.lastname: Kianzad
authors.forename: John V
authors.initials: JV
authors.lastname: Frangioni
mesh_terms: D000792:Angiography / Q000379:methods / Q000592:standards*; D000818:Animals; D004396:Coloring Agents; D004195:Disease Models, Animal; D005451:Fluorescein Angiography / Q000379:methods*; D007259:Infrared Rays; D016343:Monitoring, Intraoperative / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods; D012680:Sensitivity and Specificity; D013524:Surgical Flaps / Q000098:blood supply*; D013552:Swine; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D004396:Coloring Agents
references.citation: Plast Reconstr Surg. 2006 Sep 15;118(4):928-933
references.pmid: 16980853
references.citation: J Plast Reconstr Aesthet Surg. 2006;59(6):594-9
references.pmid: 16716952
references.citation: Plast Reconstr Surg. 1992 Feb;89(2):181-215
references.pmid: 1732886
references.citation: Microsurgery. 2008;28(6):417-23
references.pmid: 18623155
references.citation: Ann Plast Surg. 2008 Jan;60(1):29-36
references.pmid: 18281792
references.citation: Clin Plast Surg. 2003 Jul;30(3):347-57, v-vi
references.pmid: 12916592
references.citation: Plast Reconstr Surg. 2007 Feb;119(2):18e-30e
references.pmid: 17230075
references.citation: Ann Surg Oncol. 2006 Dec;13(12):1671-81
references.pmid: 17009138
references.citation: Br J Plast Surg. 1998 Apr;51(3):202-9
references.pmid: 9664879
references.citation: Plast Reconstr Surg. 2007 Jan;119(1):18-27
references.pmid: 17255652
references.citation: Microvasc Res. 1994 Mar;47(2):240-51
references.pmid: 8022322
references.citation: Plast Reconstr Surg. 2008 Jan;121(1):9-16
references.pmid: 18176200
references.citation: Microsurgery. 2002;22(7):278-87
references.pmid: 12404345
references.citation: J Plast Reconstr Aesthet Surg. 2006;59(6):585-93
references.pmid: 16716951
references.citation: Plast Reconstr Surg. 2009 Mar;123(3):125e-127e
references.pmid: 19319038
references.citation: J Plast Reconstr Aesthet Surg. 2009 Sep;62(9):1112-7
references.pmid: 18675605
references.citation: Microsurgery. 2008;28(4):227-32
references.pmid: 18335455