title: Prefabricated Cervical Skin Flaps for Hemi-Facial Resurfacing: Elucidating the Natural History of Postoperative Edema Using Indocyanine Green.
abstract: The increases in capillary wall permeability and capillary hydrostatic pressure are considered to be the causes for the acute swelling seen in flaps; however, disruption of the circulating flap lymphatics could be another contributory factor. In this study we monitor the development of flap edema in a series of 18 prefabricated flaps and aim to delineate the natural history of this phenomenon by use of lymphography.
  
  
  
  Postoperative swelling was monitored in a series of 18 pre-expanded prefabricated cervical skin flaps used for hemi-facial burns-scar resurfacing. Time to spontaneous resolution, presence or absence of venous congestion, and clinical outcome were recorded. In two cases, indocyanine-green (ICG) lymphography was used to monitor the dermal backflow pattern until swelling had completely resolved. Average moving velocity of ICG after injection as well as flap thickness was also recorded over the follow-up period.
  
  
  
  The average moving velocity of ICG in the flap lymphatics improved from 0.48 cm/min to 1.5 cm/min in the first 12 days after flap transfer. The dermal backflow pattern was stardust in the first 12 days, indicating moderate lymphedema, transforming to splash from week three, and a robust collecting lymphatic vessel occurring from the fifth month, indicating mild lymphedema and lymphatic channel recovery, respectively.
  
  
  
  Transient swelling was observed in all prefabricated flaps in our series. We postulate that this is mostly secondary to lymphatic disruption that subsides as lymphangiogenesis takes place. ICG lymphography is an inexpensive, safe, and easy-to-use imaging technology that could be used in the monitoring of postoperative lymphedema seen in prefabricated flaps.
authors.affiliation: 1 Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine , Shanghai, China .
authors.forename: Ke
authors.initials: K
authors.lastname: Li
authors.affiliation: 1 Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine , Shanghai, China .
authors.forename: Peiru
authors.initials: P
authors.lastname: Min
authors.affiliation: 2 The Royal London Hospital , Department of Plastic Reconstructive Surgery, London, United Kingdom .
authors.forename: Parviz
authors.initials: P
authors.lastname: Sadigh
authors.affiliation: 3 Department of Plastic and Reconstructive Surgery, Marche Polytechnic University Medical School, University Hospital of Ancona , Ancona, Italy .
authors.forename: Luca
authors.initials: L
authors.lastname: Grassetti
authors.affiliation: 4 Plastic Reconstructive and Aesthetic Surgery Unit, Villa Salaria Clinic , Rome, Italy .
authors.forename: Davide
authors.initials: D
authors.lastname: Lazzeri
authors.affiliation: 4 Plastic Reconstructive and Aesthetic Surgery Unit, Villa Salaria Clinic , Rome, Italy .
authors.forename: Matteo
authors.initials: M
authors.lastname: Torresetti
authors.affiliation: 5 Plastic and Reconstructive Surgery Unit, Hospital of Pisa , Pisa, Italy .
authors.forename: Riccardo
authors.initials: R
authors.lastname: Marsili
authors.affiliation: 1 Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine , Shanghai, China .
authors.forename: Shaoqing
authors.initials: S
authors.lastname: Feng
authors.affiliation: 1 Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine , Shanghai, China .
authors.forename: Ningfei
authors.initials: N
authors.lastname: Liu
authors.affiliation: 1 Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine , Shanghai, China .
authors.forename: Yi Xin
authors.initials: YX
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D000328:Adult; D002056:Burns / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002648:Child; D002921:Cicatrix / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D004396:Coloring Agents / Q000493:pharmacokinetics; D005145:Face / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007208:Indocyanine Green / Q000493:pharmacokinetics; D042583:Lymphangiogenesis / Q000502:physiology*; D042601:Lymphatic Vessels / Q000000981:diagnostic imaging / Q000601:surgery; D008209:Lymphedema / Q000000981:diagnostic imaging / Q000473:pathology*; D008220:Lymphography; D008297:Male; D011184:Postoperative Period; D019651:Plastic Surgery Procedures / Q000379:methods; D020127:Recovery of Function; D013524:Surgical Flaps / Q000637:transplantation*
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green