Reconstruction using a divided latissimus dorsi muscle flap after conventional posterolateral thoracotomy and the effectiveness of indocyanine green-fluorescence angiography to assess intraoperative blood flow.
OBJECTIVE
In most general thoracic operations performed via standard posterolateral thoracotomy, such as for descending aortic aneurysms and lung cancer, the latissimus dorsi (LD) muscle is divided. However, division of the LD can hamper reconstructive surgery because the initial operation creates unstable blood flow to the divided LD. We conducted this study to assess blood flow in a divided distal LD muscle flap using intraoperative indocyanine green-fluorescence angiography (ICG-FA) with the Hyper Eye Medical System(®) (Mizuho Medical Co., Ltd., Tokyo, Japan).


METHODS
The subjects were 11 patients who underwent posterolateral thoracotomy with reconstructive surgery using a divided distal LD and other peripheral muscle flaps. Intraoperative ICG-FA was conducted to assess blood flow to the LD.


RESULTS
Intraoperative ICG-FA revealed that at least two intercostal perforators from the sixth to the tenth intercostal spaces were preserved as feeding vessels to the divided distal LD. There were no major complications associated with inadequate blood flow to the muscle flaps.


CONCLUSIONS
Intraoperative ICG-FA proved extremely useful for assessing altered blood flow of the divided LD and for selecting preserved intercostal perforators.
Department of Plastic and Reconstructive Surgery, Kochi Medical School Hospital, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan. jm-motone-k@kochi-u.ac.jp.
Motone
M
Kuriyama
Department of Plastic and Reconstructive Surgery, Kochi Medical School Hospital, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.
Akiko
A
Yano
Department of Plastic and Reconstructive Surgery, Kochi Medical School Hospital, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.
Yukitaka
Y
Yoshida
Department of Plastic and Reconstructive Surgery, Kochi Medical School Hospital, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.
Maiko
M
Kubo
Department of Plastic, Reconstructive and Aesthetic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 206-8677, Japan.
Shinsuke
S
Akita
Department of Plastic, Reconstructive and Aesthetic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 206-8677, Japan.
Nobuyuki
N
Mitsukawa
Department of Plastic, Reconstructive and Aesthetic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 206-8677, Japan.
Kaneshige
K
Satoh
Aortic Center, Kawasaki Saiwai Hospital, 31-27, Ohmiyacho, Saiwai-ku, Kawasaki, Kanagawa, 212-0014, Japan.
Shin
S
Yamamoto
Aortic Center, Kawasaki Saiwai Hospital, 31-27, Ohmiyacho, Saiwai-ku, Kawasaki, Kanagawa, 212-0014, Japan.
Shiro
S
Sasaguri
Department of Surgery 2, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.
Kazumasa
K
Orihashi
D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery*; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D007208:Indocyanine Green; D007432:Intraoperative Period; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods*; D012039:Regional Blood Flow; D064171:Superficial Back Muscles / Q000098:blood supply*; D013524:Surgical Flaps / Q000502:physiology*; D013908:Thoracotomy / Q000379:methods*; D016896:Treatment Outcome
D007208:Indocyanine Green
Divided latissimus dorsi muscle; Indocyanine green-fluorescence angiography; Perforator flap; Posterolateral thoracotomy