Intraoperative fluorescent angiography analysis for head and neck micro-vascula free flap reconstruction- a preliminary experience

Abstract

Purpose: 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. Method: 231 head and neck free tissue transfer cases on 228 patients performed by a single surgeon between 20032013 were reviewed for type of flap, flap success and complications. In 62 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 inset flap. Conventional subjective patency test and clinical inspection were performed for the remaining 169 cases. Results: Overall success rate was 95%. When ICG analysis was performed, the success rate was 97%. In the conventional group, the success rate was 94%. Overall complication rate was 11%. Post-operative complications included hematoma, venous thrombosis, infection, partial flap necrosis, and hemorrhage. In the ICG analysis cases, the overall complication rate was 5% with hematoma 3% and partial flap necrosis 2%. In the conventional subjective analysis group, the overall complication rate was 14% with post op complications of hematoma 7%, venous thrombosis 4%, infection 1%, partial flap necrosis 1% and hemorrhage 1%. Conclusions: Routine implementation of intraoperative ICG analysis can further increase the reliability of free tissue transfer reconstruction of the head and neck region.