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. 2021 Mar;14(1):16-22.
doi: 10.1177/1943387520930608. Epub 2020 Jun 15.

Serial Perioperative Assessment of Free Flap Perfusion With Laser Angiography

Anthony Massaro  1 , Juliana Gomez  1 , Ashleigh Michelle Weyh  1 , Anthony Bunnell  1 , Matthew Warrick  2 , Philip Pirgousis  1   3 , Rui Fernandes  1
Affiliations

Serial Perioperative Assessment of Free Flap Perfusion With Laser Angiography

Anthony Massaro et al. Craniomaxillofac Trauma Reconstr. 2021 Mar.

Abstract

Study design: Prospective cohort study.

Objective: Reconstruction with microvascular free flaps is quite predictable but excessive fluids intraoperatively and excessive use of vasopressors have been implicated in postoperative complications. However, vasopressors assist in limiting fluid administration and counteract vasodilatory effects of general anesthetics, while maintaining proper intravascular volume. This is of paramount importance during surgery to ensure adequate tissue and organ perfusion. The purpose of this study is to quantify perfusion changes in free flaps at specific time points during peri- and postoperative periods, incorporating SPY technology.

Methods: A prospective study of patients who underwent free flap reconstruction was conducted (n = 9), using SPY laser angiography with indocyanine green to assess effects of general anesthetics and vasopressors on flap perfusion. Free flaps were evaluated prior to pedicle division, after inset and anastomosis, and in the immediate postoperative setting. Mean perfusion, mean arterial pressure, total operative time, fluid shifts, and vasopressor use were recorded. Data were analyzed with univariate and multivariable analyses.

Results: Those with major complications in this cohort, on average received less vasopressors, had shorter operation times and less blood loss, however, they received more fluids intraoperatively.

Conclusion: Changes in mean perfusion to the free flap during the intraoperative and immediate postoperative period are nominal.

Keywords: fluorescent imaging; free flap; indocyanine green; intraoperative laser angiography; microvascular surgery; perfusion.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: All authors have viewed and agree to this submission. The SPY elite packages used for this study were donated for research purposes by NovaDaq, which has since been acquired by Stryker.

Figures

Figure 1.
Figure 1.
Snapshots through time of indocyanine green flowing across the anastomotic site in the neck to a fibula free flap visualized using the SPY system. Image on left occurs at beginning of injection of indocyanine green, and next 2 images to the right demonstrate perfusion to the flap as time passes. Perfusion is correlated with fluorescence on the image.
Figure 2.
Figure 2.
Depiction of relative and absolute perfusion measuring flap perfusion.
Figure 3.
Figure 3.
Mean perfusion and mean arterial pressure over 3 time points.
See this image and copyright information in PMC

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