Indocyanine green fluorescence video-angiography for flap perfusion assessment in head and neck reconstruction: a prospective study.

IF 1.9 3区医学 Q2 OTORHINOLARYNGOLOGY European Archives of Oto-Rhino-Laryngology Pub Date : 2025-02-01 Epub Date: 2024-09-06 DOI:10.1007/s00405-024-08959-5

Andrea Galli, Emilio Salerno, Chiara Bramati, Rosa Alessia Battista, Michela Nicole Melegatti, Elisa Dolfato, Gabriella Fusca, Carlo Pettirossi, Vittorio Gioffré, Marco Familiari, Diego Barbieri, Pietro Indelicato, Aurora Mirabile, Mario Bussi, Leone Giordano

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Abstract

Purpose: Managing postoperative complications is crucial in reconstructive surgery. Indocyanine green fluorescence video-angiography (ICGA) aids in assessing flap vascularization intraoperatively, potentially reducing complications.

Methods: An ambispective study enrolled head and neck cancer patients undergoing ablative surgery with soft tissue reconstruction. An experimental arm (March 2021-May 2023) used ICGA, while a control arm (January 2017-December 2020) did not. Complications were graded by Clavien-Dindo classification. We also evaluated the effect of systemic inflammation on the sensitivity of ICGA in detecting hypoperfused areas of the flap.

Results: Complications were less frequent in the experimental arm, both overall (11.4% vs. 36.4%) and major ones (Clavien-Dindo ≥ 3) (8.6% vs. 30.9%). ICGA showed a protective effect in univariate and multivariate analyses. Previous radiation and ICGA were independent predictors of major complications. ICGA altered the surgical strategy in 25.7% of cases.

Conclusions: Real-time perfusion assessment, particularly with ICGA, can improve outcomes in head and neck cancer patients undergoing soft tissue reconstruction by reducing complications. Further research with larger cohorts is warranted for validation.

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用于头颈部重建中皮瓣灌注评估的吲哚菁绿荧光视频血管造影：一项前瞻性研究。

目的：控制术后并发症是整形手术的关键。吲哚菁绿荧光视频血管造影（ICGA）有助于术中评估皮瓣血管情况，从而减少并发症：一项前瞻性研究招募了接受软组织重建消融手术的头颈部癌症患者。实验组（2021 年 3 月至 2023 年 5 月）使用 ICGA，对照组（2017 年 1 月至 2020 年 12 月）未使用 ICGA。并发症按克拉维恩-丁多分类进行分级。我们还评估了全身炎症对 ICGA 检测皮瓣低灌注区灵敏度的影响：结果：实验组的并发症发生率较低，包括总体并发症（11.4% 对 36.4%）和主要并发症（Clavien-Dindo ≥ 3）（8.6% 对 30.9%）。在单变量和多变量分析中，ICGA显示出保护作用。曾接受放射治疗和 ICGA 是主要并发症的独立预测因素。在25.7%的病例中，ICGA改变了手术策略：结论：实时灌注评估，尤其是使用 ICGA，可以减少并发症，从而改善接受软组织重建手术的头颈部癌症患者的预后。有必要对更大的群体进行进一步研究，以进行验证。

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来源期刊

European Archives of Oto-Rhino-Laryngology 医学-耳鼻喉科学

CiteScore

5.30

自引率

7.70%

发文量

537

审稿时长

2-4 weeks

期刊介绍： Official Journal of European Union of Medical Specialists – ORL Section and Board Official Journal of Confederation of European Oto-Rhino-Laryngology Head and Neck Surgery "European Archives of Oto-Rhino-Laryngology" publishes original clinical reports and clinically relevant experimental studies, as well as short communications presenting new results of special interest. With peer review by a respected international editorial board and prompt English-language publication, the journal provides rapid dissemination of information by authors from around the world. This particular feature makes it the journal of choice for readers who want to be informed about the continuing state of the art concerning basic sciences and the diagnosis and management of diseases of the head and neck on an international level. European Archives of Oto-Rhino-Laryngology was founded in 1864 as "Archiv für Ohrenheilkunde" by A. von Tröltsch, A. Politzer and H. Schwartze.