Introduction ICG fluorescent angiography is gradually gaining importance in the field of free
microvascular flap surgery. This study focuses on the anastomose and the hemodynamics
of the flap pedicle as keypoint for free flap survival and examines the intrapoerative
detection of anastomose deficiency and the importance of pedicle hemodynamics regarding
flap survival.
Material und Methods During 2/2019 to 9/2020 23 patients with head and neck cancer undergoing surgery
with free microvascular flaps were included in this study (21 radial forearm, 1 ALT,
1 pectoralis major). After anastomosis of the pedicle ICG fluorescent angiography
was performes. The results of blood flow and hemodynamics ((internal transit time,
full volume time) in the pedicle were correlated with free flap necrosis. ICG fluorescent
angiography and surgery was performed with the Zeiss Kinevo 900 microscope, the modes
Flow 800 and Infrared 800 were used for measurement.
Results There was no case of flap necrosis. In four cases (17,4 % ) occlusion of the anastomose
(one venous, three arterial) could be detected and revised intraoperatively. In one
case (4,3 % ) leakage of the anastomose was not detected until fluorescent angiography.
Measurement regarding pedicle bloodflow and hemodynamics showed strong variability
and had no influence on flap survival. There was no case of allergy or side-effect
during or after ICG administration.
Discussion From our experience, intraoperative ICG fluorescent angiography is a effective tool
for the evaluation of microvascular anastomoses in free flap surgery in head and neck
cancer. It is both effective and safe and has been established as standard procedure
in our clinic.
Poster-PDF
A-1477.pdf
ZEISS
