Predictive capability of near-infrared fluorescence angiography in submental perforator flap survival.
BACKGROUND
Perforator flaps have become increasingly popular in reconstructive surgery, as patients experience less donor-site morbidity than with conventional musculocutaneous flaps. Previously, the authors' laboratory described the intraoperative use of near-infrared fluorescence angiography for patient-specific perforator flap design. This study evaluates the predictive capability of near-infrared fluorescence angiography for flap survival in submental flap reconstruction.


METHODS
Near-infrared angiography was performed using indocyanine green at 0, 0.5, 24, 48, and 72 hours after surgery for flap creation in 12 pigs. A single perforator artery was preserved during flap creation based on location (central or noncentral) and dominance (dominant or nondominant). Venous drainage, arterial perfusion, and perfused area as a percentage of total flap area were analyzed. Clinical assessments of perfusion were compared with those made using near-infrared imaging and histology.


RESULTS
Use of near-infrared fluorescence angiography immediately after flap creation accurately predicted areas of perfusion at 72 hours (p=0.0013), compared with the initial clinical assessment (p=0.3085). Identification of necrosis by histology at 72 hours correlated with near-infrared findings of insufficient arterial perfusion immediately after flap creation. No statistically significant differences in perfusion metrics were detected based on location or dominance of the preserved perforator; however, flaps containing central perforators had a higher percentage perfused area than those with noncentral perforators.


CONCLUSIONS
The use of near-infrared angiography immediately after flap creation can predict areas of perfusion at 72 hours. This predictive capability may permit intraoperative revision of compromised flaps that have a high likelihood of failure.
Boston, Mass.; and Sapporo, Japan From the Division of Hematology/Oncology, Department of Medicine, the Division of Plastic and Reconstructive Surgery, Department of Surgery, and the Department of Radiology, Beth Israel Deaconess Medical Center; the Division of Cancer Diagnostics and Therapeutics, Hokkaido University Graduate School of Medicine; and the Department of Surgery, Brigham & Women's Hospital.
Aya
A
Matsui
Bernard T
BT
Lee
Joshua H
JH
Winer
Rita G
RG
Laurence
John V
JV
Frangioni
D000818:Animals; D004396:Coloring Agents; D005260:Female; D005451:Fluorescein Angiography; D006085:Graft Survival; D007208:Indocyanine Green; D007259:Infrared Rays; D011237:Predictive Value of Tests; D012039:Regional Blood Flow; D013524:Surgical Flaps / Q000098:blood supply*; D034421:Sus scrofa
D004396:Coloring Agents; D007208:Indocyanine Green