Flap warming improves intraoperative indocyanine green angiography (ICGA) assessment of perfusion. An experimental study.

Animals Fluorescein Angiography / methods Fluorescent Dyes Graft Survival Indocyanine Green Perforator Flap / blood supply Plastic Surgery Procedures / methods Swine
Flap survival ICG angiography Perforator flap

Journal

Journal of plastic, reconstructive & aesthetic surgery : JPRAS
ISSN: 1878-0539
Titre abrégé: J Plast Reconstr Aesthet Surg
Pays: Netherlands
ID NLM: 101264239

Informations de publication

Date de publication:
Jul 2019
Historique:
received: 17 11 2018
revised: 16 01 2019
accepted: 10 03 2019
pubmed: 7 4 2019
medline: 21 4 2020
entrez: 7 4 2019
Statut: ppublish

Résumé

Indocyanine green angiography (ICGA) is slowly replacing conventional methods of evaluating perfusion during flap surgery. Microcirculatory changes during flap elevation create a marked state of hypoperfusion intraoperatively leading to ICGA underestimation of tissue viability and consequent resection of viable tissue. We propose a novel method of flap warming to induce maximum vasodilation before performing ICGA to increase accuracy in assessing perfusion. Submental flaps harvested on a single perforator were created in 8 pigs. ICG angiography was performed in the intraoperative phase (ICGA-C), after inducing maximum vasodilatation by warming the flap at 42 °C (ICGA-W) and at 24H postoperative (ICGA-24). By setting a fluorescence threshold of 33% as indicative of necrosis, the flap surface deemed viable by ICGA was measured for ICGAC, ICGAW and ICGA24. The results were then compared to the actual flap survival observed clinically at 7 days. The mean of ICG-C predicted flap survival (FS-C = 49.17%) is 12.97% lower than the mean of actual flap survival on postoperative day 7 (FS = 62.14%). The mean difference between ICG-W and ICG-24 predicted flap survival (FS-W and FS-24) and actual flap survival in the postoperative day 7 (FS) is lower, 3.13% and 2.15%, respectively. Average perfusion recovery over 24 h was 10.83% (FS-24-FS-C). Conventional intraoperative ICGA underestimated perfusion in all cases. Warming the flap intraoperatively and achieving maximum vasodilation mitigates the effects of vasoconstriction and mimics the microcirculatory environment encountered at 24 h. Performing angiography after induced vasodilation improves ICGA assessment of flap perfusion.

Sections du résumé

BACKGROUND BACKGROUND
Indocyanine green angiography (ICGA) is slowly replacing conventional methods of evaluating perfusion during flap surgery. Microcirculatory changes during flap elevation create a marked state of hypoperfusion intraoperatively leading to ICGA underestimation of tissue viability and consequent resection of viable tissue. We propose a novel method of flap warming to induce maximum vasodilation before performing ICGA to increase accuracy in assessing perfusion.
METHODS METHODS
Submental flaps harvested on a single perforator were created in 8 pigs. ICG angiography was performed in the intraoperative phase (ICGA-C), after inducing maximum vasodilatation by warming the flap at 42 °C (ICGA-W) and at 24H postoperative (ICGA-24). By setting a fluorescence threshold of 33% as indicative of necrosis, the flap surface deemed viable by ICGA was measured for ICGAC, ICGAW and ICGA24. The results were then compared to the actual flap survival observed clinically at 7 days.
RESULTS RESULTS
The mean of ICG-C predicted flap survival (FS-C = 49.17%) is 12.97% lower than the mean of actual flap survival on postoperative day 7 (FS = 62.14%). The mean difference between ICG-W and ICG-24 predicted flap survival (FS-W and FS-24) and actual flap survival in the postoperative day 7 (FS) is lower, 3.13% and 2.15%, respectively. Average perfusion recovery over 24 h was 10.83% (FS-24-FS-C).
CONCLUSIONS CONCLUSIONS
Conventional intraoperative ICGA underestimated perfusion in all cases. Warming the flap intraoperatively and achieving maximum vasodilation mitigates the effects of vasoconstriction and mimics the microcirculatory environment encountered at 24 h. Performing angiography after induced vasodilation improves ICGA assessment of flap perfusion.

Identifiants

DOI: 10.1016/j.bjps.2019.03.014 PMID: 30952589
pubmed: 30952589
pii: S1748-6815(19)30123-8
doi: 10.1016/j.bjps.2019.03.014
pii:
doi:

Substances chimiques

Fluorescent Dyes 0
Indocyanine Green IX6J1063HV

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

1150-1156

Commentaires et corrections

Type : CommentIn
Type : CommentIn

Informations de copyright

Copyright © 2019 Elsevier Ltd. All rights reserved.

Auteurs

M V Muntean (MV)

Department of Plastic Surgery, "Prof. Dr. I. Chiricuta" Institute of Oncology, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania.

F Ardelean (F)

Department of Plastic Surgery, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania.

S Strilciuc (S)

Department of Neurosciences, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania; RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania. Electronic address: stefan.strilciuc@ssnn.ro.

C Pestean (C)

Department of Anaesthesiology and Reanimation, University of Agricultural Sciences and Veterinary Medicine, Cluj-Napoca, Romania.

A V Georgescu (AV)

Department of Plastic Surgery, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania.

V Muntean (V)

Department of Surgery, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania.

Articles similaires

Evaluating the efficacy of telesurgery with dual console SSI Mantra Surgical Robotic System: experiment on animal model and clinical trials.

Sudhir Prem Srivastava, Vishwajyoti Pascual Srivastava, Avinesh Singh et al.
1.00
Robotic Surgical Procedures Animals Humans Telemedicine Models, Animal

Odour generalisation and detection dog training.

Lyn Caldicott, Thomas W Pike, Helen E Zulch et al.
1.00
Animals Odorants Dogs Generalization, Psychological Smell

FBXO22 inhibits colitis and colorectal carcinogenesis by regulating the degradation of the S2448-phosphorylated form of mTOR.

Minle Li, Xuan Chen, Pengfei Qu et al.
1.00
Animals TOR Serine-Threonine Kinases Colorectal Neoplasms Colitis Mice

Use of organic material provided by an automatic enrichment device by weaner pigs and its influence on tail lesions.

Philipp Heseker, Jeanette Probst, Stefanie Ammer et al.
1.00
Animals Tail Swine Behavior, Animal Animal Husbandry

Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Flap warming improves intraoperative...
questionsmedicales.fr › Diagnostic › Techniques et procédures diagnostiques › Techniques de diagnostic ophtalmologique › Angiographie fluorescéinique › Flap warming improves intraoperative...
questionsmedicales.fr › Actions chimiques et utilisations › Utilisations spécialisées de produits chimiques › Produits chimiques de laboratoire › Indicateurs et réactifs › Luminescents › Colorants fluorescents › Flap warming improves intraoperative...
questionsmedicales.fr › Phénomènes du système immunitaire › Immunologie en transplantation › Réaction de l'hôte contre le greffon › Survie du greffon › Flap warming improves intraoperative...
questionsmedicales.fr › Composés hétérocycliques › Composés hétérocycliques à cycles fusionnés › Composés hétérobicycliques › Indoles › Vert indocyanine › Flap warming improves intraoperative...
questionsmedicales.fr › Équipement et fournitures › Reconstructions chirurgicales › Lambeaux chirurgicaux › Lambeau perforant › Flap warming improves intraoperative...
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de chirurgie reconstructive › Flap warming improves intraoperative...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Artiodactyla › Suidae › Flap warming improves intraoperative...