Indocyanine green fluorescence video-angiography for flap perfusion assessment in head and neck reconstruction: a prospective study

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发表日期：

2024年9月6日

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Andrea Galli,
Emilio Salerno,
Chiara Bramati,
Rosa Alessia Battista,
Michela Nicole Melegatti,
Elisa Dolfato,
Gabriella Fusca,
Carlo Pettirossi,
Vittorio Gioffré,
Marco Familiari,
Diego Barbieri,
Pietro Indelicato,
Aurora Mirabile,
Mario Bussi,
Leone Giordano

摘要

Purpose

Managing postoperative complications is crucial in reconstructive surgery. Indocyanine green fluorescence video-angiography (ICGA) aids in assessing flap vascularization intraoperatively, potentially reducing complications.

Methods

An ambispective study enrolled head and neck cancer patients undergoing ablative surgery with soft tissue reconstruction. An experimental arm (March 2021-May 2023) used ICGA, while a control arm (January 2017-December 2020) did not. Complications were graded by Clavien-Dindo classification. We also evaluated the effect of systemic inflammation on the sensitivity of ICGA in detecting hypoperfused areas of the flap.

Results

Complications were less frequent in the experimental arm, both overall (11.4% vs. 36.4%) and major ones (Clavien-Dindo ≥ 3) (8.6% vs. 30.9%). ICGA showed a protective effect in univariate and multivariate analyses. Previous radiation and ICGA were independent predictors of major complications. ICGA altered the surgical strategy in 25.7% of cases.

Conclusions

Real-time perfusion assessment, particularly with ICGA, can improve outcomes in head and neck cancer patients undergoing soft tissue reconstruction by reducing complications. Further research with larger cohorts is warranted for validation.