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J Reconstr Microsurg 2015; 31(01): 045-053
DOI: 10.1055/s-0034-1383821
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Vascularized Osseous Flaps and Assessing Their Bipartate Perfusion Pattern via Intraoperative Fluorescence Angiography

Ian Valerio
1   Department of Plastic and Reconstructive Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
2   Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
3   Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
,
J. Marshall Green III
1   Department of Plastic and Reconstructive Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
,
Justin M. Sacks
3   Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
,
Shane Thomas
1   Department of Plastic and Reconstructive Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
,
Jennifer Sabino
1   Department of Plastic and Reconstructive Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
,
T. Oguz Acarturk
2   Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
› Author Affiliations
Further Information

Publication History

30 January 2014

07 May 2014

Publication Date:
03 December 2014 (online)

Also available atMedOne
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Abstract

Background Large segmental bone and composite tissue defects often require vascularized osseous flaps for definitive reconstruction. However, failed osseous flaps due to inadequate perfusion can lead to significant morbidity. Utilization of indocyanine green (ICG) fluorescence angiography has been previously shown to reliably assess soft tissue perfusion. Our group will outline the application of this useful intraoperative tool in evaluating the perfusion of vascularized osseous flaps.

Methods A retrospective review was performed to identify those osseous and/or osteocutaneous bone flaps, where ICG angiography was employed. Data analyzed included flap types, success and failure rates, and perfusion-related complications. All osseous flaps were evaluated by ICG angiography to confirm periosteal and endosteal perfusion.

Results Overall 16 osseous free flaps utilizing intraoperative ICG angiography to assess vascularized osseous constructs were performed over a 3-year period. The flaps consisted of the following: nine osteocutaneous fibulas, two osseous-only fibulas, two scapular/parascapular with scapula bone, two quadricep-based muscle flaps, containing a vascularized femoral bone component, and one osteocutaneous fibula revision. All flap reconstructions were successful with the only perfusion-related complication being a case of delayed partial skin flap loss.

Conclusions Intraoperative fluorescence angiography is a useful adjunctive tool that can aid in flap design through angiosome mapping and can also assess flap perfusion, vascular pedicle flow, tissue perfusion before flap harvest, and flap perfusion after flap inset. Our group has successfully extended the application of this intraoperative tool to assess vascularized osseous flaps in an effort to reduce adverse outcomes related to preventable perfusion-related complications.

Keywords

intraoperative angiography - osseous - perfusion

Note

None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this article. Justin M. Sacks is a consultant/speaker for LifeCell Corporation. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Army, Department of Defense, or the United States Government.


This article was presented at the Annual Meeting of the Australian and New Zealand Head and Neck Cancer Society; October 2012; Brisbane, Australia and at the Annual Meeting of the Military Health System Research Symposium; August 2013; Ft Lauderdale, FL.