Abstract
Background: Assessment of tissue perfusion after irradiation of random pattern flaps still remains a challenge. Methods: Twenty-five rats received harvesting of bilateral random pattern fasciocutaneous flaps. Group 1 served as nonirradiated control group. The right flaps of the groups 2–5 were irradiated with 20 Gy postoperatively (group 2), 3 × 12 Gy postoperatively (group 3), 20 Gy preoperatively (group 4) and 3 × 12 Gy preoperatively (group 5). Imaging with infrared thermography, indocyanine green angiography and near-infrared reflectance-based imaging were performed to detect necrotic areas of the flaps. Results: Analysis of the percentage of the necrotic area of the irradiated flaps showed a statistically significant increase from day 1 to 14 only in group 5 (p < 0.05). Indocyanine green angiography showed no differences (p > 0.05) of the percentage of the nonperfused area between all days in group 1 and 3, but a decrease in group 2 in both the left and the right flaps. Infrared thermography and near-infrared reflectance-based imaging did not show evaluable differences. Conclusion: Indocyanine green angiography is more precise in prediction of necrotic areas in random pattern skin flaps when compared to hyperspectral imaging, thermography or clinical impression. Preoperative fractional irradiation with a lower individual dose but a higher total dose has a more negative impact on flap perfusion compared to higher single stage irradiation.
Highlights
Introduction iationsDefect reconstruction still remains one of the main fields of interest in plastic surgery.Assessment of flap viability has been shown to be effective using the correct length-to-width ratio in the case of random pattern flaps for clinical evaluation [1,2].When multimorbid oncological patients who might have undergone irradiation preoperatively or should undergo irradiation postoperatively, further reliable assessment of flap perfusion is necessary to avoid complications such as wound healing disorders and partial or complete flap loss [1]
This study evaluates the different imaging modalities—infrared thermography, indocyanine green angiography and near-infrared reflectance-based imaging [16,17]—to predict malperfused areas in an irradiated random pattern fasciocutaneous flap model
Postoperative irradiation resulted in weight loss of approximately 10%
Summary
Introduction iationsDefect reconstruction still remains one of the main fields of interest in plastic surgery.Assessment of flap viability has been shown to be effective using the correct length-to-width ratio in the case of random pattern flaps for clinical evaluation [1,2].When multimorbid oncological patients who might have undergone irradiation preoperatively or should undergo irradiation postoperatively, further reliable assessment of flap perfusion is necessary to avoid complications such as wound healing disorders and partial or complete flap loss [1]. Assessment of flap viability has been shown to be effective using the correct length-to-width ratio in the case of random pattern flaps for clinical evaluation [1,2]. The correct intraoperative detection of malperfused areas is one of the points of interest [1,3]. Assessment of tissue perfusion after irradiation of random pattern flaps still remains a challenge. Methods: Twenty-five rats received harvesting of bilateral random pattern fasciocutaneous flaps. Indocyanine green angiography and near-infrared reflectance-based imaging were performed to detect necrotic areas of the flaps. Results: Analysis of the percentage of the necrotic area of the irradiated flaps showed a statistically significant increase from day 1 to 14 only in group 5
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