Abstract
OBJECTIVE
1) Understand the fundamentals of intraoperative fluorescent angiography (FA); 2) Learn the potential numerous applications of fluorescent angiography in head and neck reconstruction, from local flaps to microvascular tissue transfer.
METHOD
Intraoperative fluorescent angiography was performed on reconstructive patients cared for by 2 microsurgeons at a military hospital between March 2009 and February 2010. A retrospective analysis with descriptive statistics was accomplished on this early experience.
RESULTS
Intraoperative fluorescent angiography with indocyanine green was successfully utilized in 12 reconstructive patients, including 4 patients with head and neck defects. Fluorescent angiography identified cutaneous perforators, assessed the patency of microvascular anastomoses, and determined viability of large skin paddles. In a novel application, FA clearly identified the extent of compromised native mandible in a patient with advanced osteoradionecrosis, which had been underestimated by preoperative imaging. This real-time data directly led to modifications of the operative plan in 3 patients. There were no complications and no complete flap losses in this early series.
CONCLUSION
Intraoperative fluorescent angiography with indocyanine green is a recent addition to the reconstructive armamentarium. It complements the clinical acumen and experience of the surgical team, as well as existing technologies, to assess and predict tissue viability. For the first time, this technology has been used to assess the native mandible in osteoradionecrosis - precisely guiding osteotomies and the extent of resection. Further experience with fluorescent angiography will identify additional applications in the head and neck.