Elaprolu Snigdha, Kishore P, Mathew Jimmy, Balasubramanian Deepak, Menon Lakshmi Ravunniarth, Thomas Sam, Thankappan Krishnakumar, Iyer Subramania
Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
J Plast Reconstr Aesthet Surg. 2025 Aug;107:39-48. doi: 10.1016/j.bjps.2025.06.005. Epub 2025 Jun 9.
Pedicled flaps are frequently used for reconstructing the head and neck area. Partial or complete loss can be debilitating, affecting speech, swallowing, and appearance. This is a prospective interventional study conducted in head and neck cancer patients undergoing reconstruction with pedicled flaps from August 2022 to May 2023, where the Indocyanine green-fluorescence angiography (ICG-FA) technique was employed to improve the outcomes of flap surgery. Retrospective data of pedicled flaps performed from 2021 to June 2022 were collected from medical records to compare outcomes with the prospective group. Demographics, surgery details, and flap outcomes were obtained for both groups. Data from 46 patients in the prospective group and 77 patients in the retrospective group were analyzed. Each group was further categorized into laryngeal and non-laryngeal subgroups. Distribution of age, sex, history of prior surgery, and previous radiotherapy was similar between the two groups. In the non-laryngeal group, the prospective intervention arm versus the retrospective arm had partial flap loss in 5.6% versus 22.9%. The occurrence of flap loss (partial/total) was significantly lower in the prospective group within the non-laryngeal subgroup (p=0.025). In the laryngeal subgroup, salivary leaks were used as a proxy for outcome, and there was no significant difference between both the groups (p=1.00). The prospective group experienced fewer secondary procedures, second flap surgeries, though these differences did not reach statistical significance. ICG-FA appears to be a valuable tool for assessing flap perfusion. Further research is essential to obtain objective measures of perfusion and to apply ICG-FA in specific cases to enhance cost-effectiveness.
带蒂皮瓣常用于头颈部区域的重建。部分或完全缺损可能会使人衰弱，影响言语、吞咽和外观。这是一项前瞻性干预研究，于2022年8月至2023年5月对接受带蒂皮瓣重建的头颈癌患者进行，采用吲哚菁绿荧光血管造影（ICG-FA）技术改善皮瓣手术效果。从医疗记录中收集2021年至2022年6月进行的带蒂皮瓣手术的回顾性数据，以与前瞻性组比较结果。获取两组的人口统计学、手术细节和皮瓣结果。对前瞻性组的46例患者和回顾性组的77例患者的数据进行了分析。每组进一步分为喉部和非喉部亚组。两组之间年龄、性别、既往手术史和既往放疗史的分布相似。在非喉部组中，前瞻性干预组与回顾性组的皮瓣部分丢失率分别为5.6%和22.9%。非喉部亚组中，前瞻性组皮瓣丢失（部分/全部）的发生率显著较低（p=0.025）。在喉部亚组中，唾液漏用作结果指标，两组之间无显著差异（p=1.00）。前瞻性组经历的二次手术、第二次皮瓣手术较少，尽管这些差异未达到统计学意义。ICG-FA似乎是评估皮瓣灌注的一种有价值的工具。进一步的研究对于获得灌注的客观测量方法以及在特定病例中应用ICG-FA以提高成本效益至关重要。
