Journal
ANNALS OF PLASTIC SURGERY
Volume 63, Issue 3, Pages 327-330Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/SAP.0b013e318193493d
Keywords
perforator flaps; flap design; near-infrared fluorescence imaging; x-ray angiography; indocyanine green
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Funding
- NIH [R01-EB-005805, R01-CA-115296]
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Although perforator flaps mark an important conceptual change in reconstructive surgery, individual perforator vessels show a high degree of variability with respect to anatomic landmarks. We have developed an intraoperative imaging system that simultaneously displays surgical anatomy and otherwise invisible near-infrared images. In 22 adult pigs, perforating vessels were identified within seconds using this optical imaging system and systemic injection of indocyanine green. Perforator flaps were then designed based on these results, and vessel location confirmed by direct visualization and anatomic dissection. Since x-ray angiography remains the gold standard for identification of underlying vessels, conventional x-ray angiography was also performed in 8 pigs to verify the location of perforators. There was full correlation of all the perforators identified among near-infrared fluorescence angiography, x-ray angiography, and anatomic dissection. The technology we describe provides high-sensitivity real-time image guidance throughout perforator dissection, and permits patient-specific flap design.
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