Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.
Department of Plastic and Reconstructive Surgery, Luzerner Kantonsspital, Lucerne, Switzerland.
Microsurgery. 2021 Sep;41(6):522-526. doi: 10.1002/micr.30734. Epub 2021 Mar 25.
The use of intraoperative indocyanine green (ICG) angiography has been well documented for confirmation of arterial perfusion in transferred free flaps. However, no previous report has yet focused on whether ICG angiography can be used to detect congestion in free flaps. The present report investigates the feasibility of ICG angiography for detecting flap congestion intraoperatively through illustrative cases.
From September 2019 to September 2020, 65 consecutive female patients who underwent breast reconstructions using a free deep inferior epigastric perforator (DIEP) flap were enrolled in this study. Forty-eight patients with 52 DIEP flaps were eligible for the study after application of the exclusion criteria. ICG angiography was performed after elevation of the flap, after completion of the anastomoses, and after inset of the flap.
In five cases (9.6%), an inadequate highlight was demonstrated with ICG angiography performed after flap elevation. All such cases were deemed congestive since robust bleeding was observed with the prick test. ICG angiography demonstrated sufficient highlight of the flap after removal of the clamp on the superficial inferior epigastric vein. In two cases (4.2%), kinking of the pedicle vein of the DIEP flap was found with ICG angiography performed after inset of the flap. In both cases, the pedicle and the flap were reinset. All flaps survived completely postoperatively.
ICG angiography can detect flap congestion, and the proposed 3-step protocol is useful for the prevention of postoperative complications.
术中吲哚菁绿（ICG）血管造影已被广泛用于确认游离皮瓣的动脉灌注。然而，目前尚无研究关注 ICG 血管造影是否可用于检测游离皮瓣的淤血。本研究通过病例说明来探讨术中 ICG 血管造影检测皮瓣淤血的可行性。
2019 年 9 月至 2020 年 9 月，共纳入 65 例行游离腹壁下深动脉穿支（DIEP）皮瓣乳房再造的女性患者。应用排除标准后，48 例患者的 52 个 DIEP 皮瓣符合纳入标准。皮瓣抬起后、吻合完成后及皮瓣植入后分别进行 ICG 血管造影。
在 5 例（9.6%）患者中，ICG 血管造影显示皮瓣抬起后皮瓣显影不佳。由于针刺试验显示有明显出血，所有此类患者均被认为是淤血。在移除腹壁下浅静脉夹后，ICG 血管造影显示皮瓣显影良好。在 2 例（4.2%）患者中，ICG 血管造影显示 DIEP 皮瓣的蒂静脉扭曲。在这两例患者中，均重新调整了蒂和皮瓣。所有皮瓣术后均完全存活。
ICG 血管造影可检测皮瓣淤血，所提出的 3 步方案有助于预防术后并发症。
