OP105: Intraoperative fluorescent angiography analysis for head and neck micro-vascular free flap reconstruction – A preliminary experience

• Published in: Oral oncology Vol. 49; p. S46
• Main Authors: Kim, D. David, Yeoh, Melvyn S.
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01.05.2013
• ISSN: 1368-8375; 1879-0593
• DOI: 10.1016/j.oraloncology.2013.03.113

Reconstruction of complex defects of the head and neck region utilizing micro-vascular free tissue transfer reconstruction has become invaluable. Early detection of vascular compromise and its prompt correction is critical to its success. The use of intra-operative fluorescent angiography (ICG) may facilitate surgeons in being objective when assessing micro-vascular anastamosis patency and flap perfusion. 201 head and neck free tissue transfer cases on 198 patients performed by a single surgeon between 2003 and 2012 were reviewed for type of flap, flap success and complications. In 32 of the head and neck free tissue transfer cases, intra-operative ICG was performed with SPY Elite (Lifecell) for assessment of micro-vascular anastomosis patency and analysis of adequacy of blood supply to all zones of the inset flap. Conventional subjective patency test and clinical inspection were performed for the remaining 169 cases. Overall success rate was 95% (191/201) with eight flap failures and two partial flaps necrosis. When intra-operative ICG analysis was performed, the success rate was 97% (31 out of 32) with 1 partial flap necrosis. In the conventional subjective analysis group, the success rate was 94% (160/169) with eight flap failures and one partial flap necrosis. Overall complication rate was 12% (25/201). Post-operative complications included hematoma, venous thrombosis, infection, partial flap necrosis, and hemorrhage. In the intraoperative ICG analysis cases, the overall complication rate was 6% (2/32 cases) with 3% (1/32) hematoma and 3% (1/32) partial flap necrosis. In the conventional subjective analysis group, the overall complication rate was 16% (23/169) with post op complications of hematoma 7% (12/169), venous thrombosis 4% (7/169), infection 1% (2/169), partial flap necrosis 1% (2/169) and hemorrhage 0.6% (1/169). Routine implementation of intraoperative ICG analysis can further increase the reliability of free tissue transfer reconstruction of the head and neck region.