JNL: Quantitative assessment of perfusion and vascular compromise in perforator flaps using a near-infrared fluorescence-guided imaging system
Plast
Reconstr Surg. 2009 Aug;124(2):451-60.
Quantitative assessment of perfusion and
vascular compromise in perforator flaps using a near-infrared
fluorescence-guided imaging system.
Matsui
A, Lee
BT, Winer
JH, Laurence
RG, Frangioni
JV.
Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess
Medical Center, Boston, Mass 02215, USA.
BACKGROUND: Techniques currently used to determine flap perfusion are mainly
subjective, with the majority of reconstructive surgeons still relying on
clinical examination. In this study, the authors demonstrate the use of
near-infrared fluorescence angiography to directly quantify normal and abnormal
perfusion in perforator flaps. METHODS: Indocyanine green was injected
intravenously into anesthetized adult pigs (n = 38). A custom near-infrared
fluorescence imaging system was used for image acquisition and quantitation.
Thirty-nine flaps were designed based on identified perforators, and
postoperative imaging was performed for comparison. In select flaps, isolated
occlusion of the arterial and venous pedicle was performed. In select flaps,
vascular spasm was induced by local irrigation of the vessels with epinephrine.
The fluorescence intensities of select regions of interest were quantified.
From these data, the authors defined two indices for abnormal perfusion: the
Tmax ratio and the drainage ratio. RESULTS: The authors identified a normal
pattern of perfusion before flap elevation, composed of a distinct fluorescence
intensity peak at maximal arterial inflow followed by a smooth drop representing
venous drainage. Delay of this peak after flap elevation, as indicated by the
Tmax ratio, identified vascular spasm and arterial occlusion (p < 0.0001).
Abnormal fall of fluorescence intensities after this peak, as indicated by the
drainage ratio, identified venous occlusion (p < 0.0001). CONCLUSIONS:
Quantitation of fluorescence intensities by near-infrared angiography
accurately characterizes arterial and venous compromise. The authors' technique
can assess perfusion characteristics during the intraoperative and
postoperative periods and therefore complements clinically based subjective
criteria now used for flap assessment.
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