Intraoperative Fluorescence Angiography for Head and Neck Reconstruction

Abstract

Purpose of Review

Reconstruction of head and neck defects that cannot be closed primarily often requires the use of complex locoregional, pedicled, or microvascular flaps. Success of the reconstruction relies on the vascular supply of these flaps to prevent major and sometimes life-threatening wound complications. Intraoperative fluorescence angiography is an emerging aspect of the field that can be used as an adjunct to other methods to identify vascular compromise before, during, and after reconstruction.

Recent Findings

Laser-assisted near-infrared angiography with intravenous indocyanine green (ICG) dye has been used to perform optical angiography in plastic surgery to help determine the recipient tissue perfusion at the defect site as well as the perfusion of the tissue used for reconstruction. This method allows for quantification of perfusion in skin and soft tissue reconstruction.

Summary

Laser-assisted near-infrared angiography with intravenous ICG dye is fast, reliable, safe and can have many uses in head and neck reconstruction including the ability to quantitatively assess perfusion in perforators and angiosomes in flap design, prior to completion of harvest, during, and after the microvascular anastomosis, and in the distal edges of rotational and pedicled flaps. It can also be used to objectively view the native tissue prior to reconstruction, especially in patients with a history of radiation or chemotherapy.

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