Outcome analysis of free flap reconstruction for head and neck cancer with intraoperative indocyanine green angiography

Background: Intraoperative indocyanine green (ICG) angiography is used in free flap surgery to evaluate the patency of vessel anastomosis. This study evaluated the outcomes of intraoperative ICG angiography in free flap surgery for head and neck cancer. Materials and methods: This was a retrospective study of free flap reconstruction for head and neck cancer performed between 2015 and 2021. The outcomes analyzed were the total flap failure rate, re-exploration rate, and flap salvage rate. Differences in outcomes were compared in patients treated using intraoperative ICG angiography and those treated without. Results: Of the 520 free flap surgeries in the 486 enrolled patients, 259 cases underwent in- traoperative ICG angiography. In this group, there were 10 (3.9%) cases of total flap failure. In the non-ICG group, there were 22 cases (8.4%). There were 35 (13.5%) cases requiring re -ex- ploration in the ICG group and 40 (15.3%) in the non-ICG group. The difference was not sta- tistically significant. The flap salvage rate was 75.8% (25/33) in the ICG group and 51.4% (18/35) in the non-ICG group, which was a significant difference. Conclusion: We found that free flap surgery with intraoperative ICG angiography significantly decreased total flap failure rate and significantly increased salvage rate but did not sig- nificantly affect the re-exploration rate. & COPY; 2023 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Automated summary

This study evaluated the outcomes of intraoperative ICG angiography in free flap surgery for head and neck cancer. The results showed that the use of intraoperative ICG angiography significantly reduced the total flap failure rate and increased the flap salvage rate, but did not significantly affect the re-exploration rate.