title: Improved technique for evaluating oral free flaps by pinprick testing assisted by indocyanine green near-infrared fluorescence angiography.
abstract: In head and neck surgery, free-flap reconstruction using a microvascular anastomosis is an indispensable option after tumor ablation. Because the success of free-flap reconstruction is enhanced by rapid identification and salvage of failing flaps, postoperative monitoring of free flaps is essential. We describe a new technique using indocyanine green (ICG) near-infrared angiography and pinprick testing to monitor intraoral free flaps. A solution of ICG (Diagnogreen, 5 ml) was intravenously injected, and scanning was performed with a near-infrared video camera system. Thirty seconds after ICG injection, a pinprick test was performed by placing a 24-gage needle through the dermis to the subcutaneous fat of the flap. Pinprick testing during ICG fluorescence imaging was performed in 30 patients. Flap perfusion was confirmed in all patients, and all flaps survived postoperatively. ICG fluorescence imaging demonstrated that flap perfusion was maintained.
authors: Department of Oral and Maxillofacial Surgery (Chief: Prof. Fuminori Katou), Hamamatsu University School of Medicine, 1-20-1 Handa-yama, Higashi-ku, Hamamatsu City, Shizuoka 431-3125, Japan. Electronic address: nagatez@hama-med.ac.jp.
authors: Tetsuji
authors: T
authors: Nagata
authors: Department of Oral and Maxillofacial Surgery (Chief: Prof. Fuminori Katou), Hamamatsu University School of Medicine, 1-20-1 Handa-yama, Higashi-ku, Hamamatsu City, Shizuoka 431-3125, Japan.
authors: Kazuma
authors: K
authors: Masumoto
authors: Department of Oral and Maxillofacial Surgery (Chief: Prof. Fuminori Katou), Hamamatsu University School of Medicine, 1-20-1 Handa-yama, Higashi-ku, Hamamatsu City, Shizuoka 431-3125, Japan.
authors: Yoshiyuki
authors: Y
authors: Uchiyama
authors: Department of Oral and Maxillofacial Surgery (Chief: Prof. Fuminori Katou), Hamamatsu University School of Medicine, 1-20-1 Handa-yama, Higashi-ku, Hamamatsu City, Shizuoka 431-3125, Japan.
authors: Yoshiko
authors: Y
authors: Watanabe
authors: Department of Plastic Surgery, National Defense Medical College, Tokorozawa, Japan.
authors: Ryuichi
authors: R
authors: Azuma
authors: Department of Integrative Physiology and Bio-Nano Medicine, National Defense Medical College, Tokorozawa, Japan.
authors: Yuji
authors: Y
authors: Morimoto
authors: Department of Oral and Maxillofacial Surgery (Chief: Prof. Fuminori Katou), Hamamatsu University School of Medicine, 1-20-1 Handa-yama, Higashi-ku, Hamamatsu City, Shizuoka 431-3125, Japan.
authors: Fuminori
authors: F
authors: Katou
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D002196:Capillaries / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D004396:Coloring Agents / Q000008:administration & dosage; D005260:Female; D005451:Fluorescein Angiography / Q000379:methods*; D058752:Free Tissue Flaps / Q000098:blood supply / Q000637:transplantation*; D005887:Gingival Neoplasms / Q000601:surgery; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D007208:Indocyanine Green / Q000008:administration & dosage; D007275:Injections, Intravenous; D008297:Male; D008441:Maxillary Neoplasms / Q000601:surgery; D008875:Middle Aged; D009055:Mouth / Q000601:surgery*; D009339:Needles; D019651:Plastic Surgery Procedures / Q000379:methods*; D019265:Spectroscopy, Near-Infrared / Q000379:methods; D014062:Tongue Neoplasms / Q000601:surgery; D014110:Touch / Q000502:physiology*; D014741:Video Recording / Q000379:methods; D055815:Young Adult
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green
keywords: Free-tissue transfer; Indocyanine green; Microsurgery; Monitoring technique; Near-infrared angiography