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CC BY-NC-ND 4.0 · J Reconstr Microsurg Open 2018; 03(02): e62-e69
DOI: 10.1055/s-0038-1675408
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Prediction of Flap Necrosis by Using Indocyanine Green Videoangiography in Cases of Venous Occlusion in the Epigastric Flap Model of the Rat

Lucas M. Ritschl
1   Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, München, Germany
,
Leonard H. Schmidt
1   Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, München, Germany
,
Andreas M. Fichter
1   Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, München, Germany
,
Alexander Hapfelmeier
2   Institute for Medical Informatics, Statistics and Epidemiology, Technische Universität München, München, Germany
,
Anastasios Kanatas
3   OMFS Department, Leeds Teaching Hospitals and St James Institute of Oncology, Leeds Dental Institute and Leeds General Infirmary, United Kingdom
,
Klaus-Dietrich Wolff
1   Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, München, Germany
,
Thomas Mücke
1   Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, München, Germany
4   Department of Oral and Maxillofacial Surgery, Malteser Kliniken Rhein-Ruhr, Krefeld-Uerdingen, Germany
› Author Affiliations
Funding This work was supported by the German Research Foundation (DFG) and the Technical University of Munich within the funding programme Open Access Publishing.
Further Information

Publication History

05 February 2018

30 August 2018

Publication Date:
02 November 2018 (online)

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Abstract

Background A compromised free flap perfusion attributable to vascular occlusion requires immediate operative correction. Indocyanine green (ICG) videoangiography may reduce the risk of partial skin flap necrosis in high-risk free flaps in patients undergoing head and neck reconstruction. The purpose of this study was to determine the role of ICG in cases of venous congestion in a rat model.

Methods A standardized epigastric flap was raised and repositioned in 35 rats. Full venous occlusion of the draining superficial inferior epigastric vein was temporarily applied for 4, 5, 6, or 7 hours. Blood flow measurements including simultaneous laser-Doppler flowmetry and tissue spectrophotometry (oxygen-to-see [O2C]) and ICG videoangiography with the FLOW 800 tool were performed before flap raising, after temporary venous stasis, and after clinical monitoring for 1 week. The Youden index computed from the receiver operating characteristic curve was used to define an optimal cutoff value for necrosis prediction after 4 and 6 hours of stasis.

Results The ICG videoangiography with the FLOW 800 tool was found to be superior to O2C in the prediction of flap necrosis. The accuracy of prediction was moderate after an interval of 4 hours of stasis (area under the curve [AUC] = 0.661; 95% confidence interval [CI]: 0.489–0.834) and good after 6 hours of stasis (AUC = 0.787; 95% CI: 0.65–0.915).

Conclusions The O2C does not reliably predict tissue necrosis in cases of venous congestion. ICG videoangiography is a valuable tool that can predict clinical outcome and provide guidance on whether to salvage a congested flap.

Keywords

venous congestion - indocyanine green videoangiography - prediction of flap necrosis

Financial Disclosure

The authors have nothing to disclose.