Assessment of Fibula Flap Skin Perfusion in Patients Undergoing Oromandibular Reconstruction: Comparison of Clinical Findings, Fluorescein, and Indocyanine Green Angiography.
OBJECTIVE
Complications of partial flap necrosis contribute substantially to morbidity in patients who undergo head and neck reconstructive surgery.


OBJECTIVE
To assess the usefulness of clinical findings, intraoperative fluorescein angiography, and intraoperative indocyanine green angiography (ICGA) for evaluation of flap skin paddle perfusion in patients undergoing oromandibular reconstruction who are at high risk of partial skin paddle necrosis.


METHODS
Retrospective medical record review from May 21, 1996, to May 27, 2015, at a tertiary care academic medical center. Participants were 73 patients who underwent reconstruction of through-and-through defects of the mucosa, mandible, and skin using fibula free flaps that contained large bilobed skin paddles.


METHODS
The rates of partial skin paddle necrosis and revision reconstructive surgery.


RESULTS
The rates of partial flap necrosis were 8% (n = 2) among 25 patients in whom the skin paddle was trimmed based on ICGA and 33% (n = 16) among 48 patients in whom the skin paddle was trimmed according to clinical findings (P = .02). The rates of revision reconstructive surgery were 20% (5 of 25) when flap skin paddles were trimmed using ICGA and 42% (20 of 48) when trimmed per clinical findings (P = .06).


CONCLUSIONS
The use of ICGA may reduce the risk of partial skin flap necrosis in free flaps used in patients undergoing head and neck reconstruction who are at high risk of developing flap necrosis. Indocyanine green angiography imaging should be considered in any flap in which skin paddle viability is uncertain based on clinical findings and in patients in whom the skin paddle extends beyond the primary and adjacent angiosomes.


METHODS
3.
Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles.
Andrew D
AD
Beckler
Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles2currently with the Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts.
Waleed H
WH
Ezzat
Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles3currently with the Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco.
Rahul
R
Seth
Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles.
Vishad
V
Nabili
Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles.
Keith E
KE
Blackwell
D005360:Fibula / Q000098:blood supply / Q000637:transplantation*; D019793:Fluorescein; D005451:Fluorescein Angiography / Q000379:methods; D005456:Fluorescent Dyes; D058752:Free Tissue Flaps / Q000098:blood supply* / Q000473:pathology / Q000637:transplantation; D006801:Humans; D007208:Indocyanine Green; D008334:Mandible / Q000601:surgery*; D009055:Mouth / Q000601:surgery*; D009336:Necrosis / Q000175:diagnosis / Q000209:etiology; D011183:Postoperative Complications / Q000175:diagnosis*; D019651:Plastic Surgery Procedures / Q000379:methods; D012086:Reoperation; D012189:Retrospective Studies; D012867:Skin / Q000098:blood supply* / Q000473:pathology; D016038:Skin Transplantation
D005456:Fluorescent Dyes; D007208:Indocyanine Green; D019793:Fluorescein