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Master Thesis

Indocyanine green angiography in preoperative perforators mapping for anterolateral thigh flap: anatomical study

Abstract : Introduction. ALT flap, described by Song, is widely used in plastic and reconstructive surgery. A precise perforators planning reduces operating time and allows adapting precisely the flap to the reconstructive requirements. In a cadaveric study we evaluate the efficiency of the ICG angiography in the detection and the location of ALT perforators compared with anatomic dissection and CT angiography (CTA). Material and methods. 22 cadaveric thighs were studied. The line between the anterosuperior iliac crest (ASIC) and the superolateral edge of the patella was drawn with an indelible pen as well as the inguinal ligament. First, an indocyanine green angiography was performed to locate perforators on each thigh. Secondly, CTA was performed and perforators were characterized by coordinates (x,y) according to the previous line. And last, thighs were dissected to detect perforators. The results of imaging were compared with dissection findings. Results. Indocianyne green angiography detected 97 perforators on 22 cadaveric's thighs, CTA only 11 perforators. With anatomical dissection we found 76 surgically useful perforators. ICG angiography sensitivity was 51.3% ; its specificity was 14.7%. CTA sensitivity was 3.9 % and its specificity was 88.3%. The agreements between CTA or ICG angiography and anatomy were very low but ICG angigraphy was a little bit better. There was no significant difference between the results in good cadavers and damaged cadavers (p>0,05). Discussion. Indocyanine green angiography, a new imaging technology seems to be promising in the preoperative mapping of perforators in ALT flap. This technology could supplant the CTA in this indication. ICG angiography detects ALT perforators with a good precision for the surgeon. It has a good sensitivity which allows locating perforators with a tiny calibre. But its specificity is very low, probably due to its inability to distinguish subcutaneous vesssels from perforators. CTA seems to be not a good exam to locate ALT perforators on anatomical pieces. Its sensitivity is very low and its agreement with anatomy is very bad. On the contrary, the agreement between anatomy and ICG is better which places ICG before CTA in locating perforators in this study. ICG angiography is widely used in plastic surgery but above all to check the intraoperative perfusion of the flap. This exam is not radiant and inexpensive. A lot of methods are used in ALT perforator's mapping: doppler, MRA, CTA... But no study was published to compare CTA with ICG angiography. We have to balance these results because of the difficulty to make these two exams on cadavers. A clinical study, which will soon begin, is essential to confirm the place of choice of ICG in ALT perforators mapping.
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Master Thesis
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Submitted on : Tuesday, October 16, 2012 - 3:51:05 PM
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  • HAL Id : dumas-00741484, version 1

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Clotilde Ochala. Indocyanine green angiography in preoperative perforators mapping for anterolateral thigh flap: anatomical study. Human health and pathology. 2012. ⟨dumas-00741484⟩

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