title: Use of Intraoperative Fluorescent Indocyanine Green Angiography for Real-Time Vascular Evaluation of Pericranial Flaps.
abstract: BACKGROUND
  Pericranial flaps (PCFs) have been widely used for skull base reconstruction. The key to successful skull base reconstruction using PCF depends on flap vascularity, but there have been no reports describing the real-time vascularity of PCF. In this study, we performed intraoperative fluorescent indocyanine green angiography to evaluate the real-time vascularity and viability of PCF and to estimate the reliability of this flap.
  
  
  METHODS
  Eleven anteriorly based PCF (with a bilateral pedicle, ipsilateral pedicle, and random-pattern flap) and 11 laterally based PCF (with and without temporal muscle) were included in this study. The flap vascularity of each flap type considering the patients' background was evaluated using indocyanine green angiography intraoperatively.
  
  
  RESULTS
  Anteriorly based PCF had significantly better vascularity compared to laterally based PCF. In anteriorly based PCF, there was no significant difference in vascularity between PCF with bilateral pedicles and an ipsilateral pedicle. In laterally based PCF, PCF without temporal muscle showed a wider vascular area compared to PCF with temporal muscle. As for the patient background, those older than 45 years, body mass index more than 25, and who were smokers tended to have lower vascularity. Preoperative radiation therapy did not show any significant differences in terms of flap vascularity.
  
  
  CONCLUSIONS
  Anteriorly based PCF had significantly better vascularity compared to laterally based PCF and seemed safer to harvest regardless of flap pedicle type. Also, the feasibility of harvesting muscle sparing laterally based PCF was indicated. Finally, being older than 45 years, a body mass index more than 25, or being a smoker might increase the risk of reducing flap vascularity.
authors.affiliation: From the *Department of Plastic and Reconstructive Surgery, †Department of Otolaryngology, Tokyo Medical and Dental University, Tokyo; ‡Department of Neurosurgery, and §Department of Head and Neck Surgery, Kameda Medical Center, Chiba, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Yano
authors.forename: Mutsumi
authors.initials: M
authors.lastname: Okazaki
authors.forename: Kentaro
authors.initials: K
authors.lastname: Tanaka
authors.forename: Atsunobu
authors.initials: A
authors.lastname: Tsunoda
authors.forename: Masaru
authors.initials: M
authors.lastname: Aoyagi
authors.forename: Seiji
authors.initials: S
authors.lastname: Kishimoto
mesh_terms: D004396:Coloring Agents; D005260:Female; D006801:Humans; D007208:Indocyanine Green; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D061525:Perforator Flap / Q000098:blood supply*; D019651:Plastic Surgery Procedures / Q000379:methods*; D019291:Skull Base / Q000601:surgery*; D013524:Surgical Flaps
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green