Improved technique for evaluating oral free flaps by pinprick testing assisted by indocyanine green near-infrared fluorescence angiography

• DOI: 10.1016/j.jcms.2014.01.040
• Publication Date: 2014-01-17T15:45:58Z
• Authors: Tetsuji Nagata; Kazuma Masumoto; Yoshiyuki Uchiyama; Yoshiko Watanabe; Ryuichi Azuma; Yuji Morimoto; Fuminori Katou
• Keywords: Adult; Aged, 80 and over; Indocyanine Green; Male; Maxillary Neoplasms; Mouth; Gingival Neoplasms; Anastomosis, Surgical; Graft Survival; Middle Aged; Free Tissue Flaps; Capillaries; 03 medical and health sciences; 0302 clinical medicine; Needles; Injections, Intravenous; Carcinoma, Squamous Cell; Humans; Female; Fluorescein Angiography; Coloring Agents; Aged

In head and neck surgery, free-flap reconstruction using a microvascular anastomosis is an indispensable option after tumor ablation. Because the success of free-flap reconstruction is enhanced by rapid identification and salvage of failing flaps, postoperative monitoring of free flaps is essential. We describe a new technique using indocyanine green (ICG) near-infrared angiography and pinprick testing to monitor intraoral free flaps. A solution of ICG (Diagnogreen, 5 ml) was intravenously injected, and scanning was performed with a near-infrared video camera system. Thirty seconds after ICG injection, a pinprick test was performed by placing a 24-gage needle through the dermis to the subcutaneous fat of the flap. Pinprick testing during ICG fluorescence imaging was performed in 30 patients. Flap perfusion was confirmed in all patients, and all flaps survived postoperatively. ICG fluorescence imaging demonstrated that flap perfusion was maintained.