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Master Thesis

Indocyanine green fluorescence angiography for preoperative perforator mapping and free flap monitoring

Abstract : Indocyanine green fluorescence angiography (FA ICG) is a new method for the assessment of superficial vascularization tissue. We evaluated the effectiveness of FA ICG in mapping of perforators for fibular free flap and compared angiographic findings with ultrasonographic mapping (CDS). Then we evaluated the effectiveness and the tolerance of repeated FA ICG in perforator flap monitoring. 20 patients undergoing microsurgical reconstruction were included in our study. We used the Fluobeam device. Each patient received a total of 19 injections of 0.025 mg/kg Infracyanine®. The detection of skin perforators was performed by both CDS and FA ICG, and then compared to surgical dissection findings. The second injection was performed intra-operatively just after vascular anastomosis. Then the same dose was injected every 6 hours for 4 days. Monitoring was made by clinical examination, and then compared to angiographic findings. The sensitivity of FA ICG was 55% for a precision of 1cm, and positive predictive value was 50%. FA ICG was more accurate than CDS (p≤0.001). ICG angiography allowed detecting each intra and postoperative complication, earlier than clinical examination. The mean peroperative intensity of fluorescence was significantly lower in flaps with vascular complications (p=0.0087). The postoperative slope (p=0.0239) and amplitude (p=0.0335) of the fluorescent signal were both significantly lower than for uncomplicated flaps, before surgical revision. There was no adverse effect of ICG. FA ICG is a safe and useful technique for the mapping of fibular skin perforators, and for the detection of free flap vascular complications.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-00998699
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Submitted on : Monday, June 2, 2014 - 3:10:22 PM
Last modification on : Tuesday, May 11, 2021 - 11:36:17 AM
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  • HAL Id : dumas-00998699, version 1

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Marine Hitier. Indocyanine green fluorescence angiography for preoperative perforator mapping and free flap monitoring. Human health and pathology. 2014. ⟨dumas-00998699⟩

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