Case Report: Indocyanine Green-Based Angiography for Real-Time Assessment of Superficial Brachialis Axial Pattern Flap Vascularization in Two Dogs

Abstract

This case report describes the method and feasibility of near-infrared angiography (NIRA) to improve the surgical procedure of two superficial brachial axial pattern flaps intraoperatively using two camera systems. Two client-owned dogs were treated for tumors on their antebrachia with wide surgical excision. The defects were closed with a superficial brachial flap in both cases. A different NIRA camera system was used for each case to identify the perforator vessel and flap margins accordingly. Case 1 developed a seroma and healed without further complications. Case 2 developed partial flap necrosis, underwent revision surgery, and healed by secondary intent. NIRA proved useful intraoperatively in identifying the perforator vessel and determining flap margins. As these are only two cases, caution should be used in extrapolating the results.

Keywords: ICG; Indocyanine Green; NIRA; axial pattern flaps; near infrared angiography; skin reconstruction; superficial brachial.

Figure 1

Photographs of dog 1, showing (A) the soft tissue sarcoma preoperatively, (B) the delineation of the superficial brachial artery using the IC-Flow™ camera system intraoperatively, and (C) flap edema at day 20 postoperatively.

Figure 2

Photographs of dog 2, showing (A) the dehiscent wound on the left medio-proximal antebrachium at presentation, (B) the delineation of the superficial brachial artery using the VisionSense VS3-IR-MMS camera system intraoperatively, and (C) the discoloration of the distal edges of the flap on day 6 postoperatively.

Figure 3

Photographs of the near-infrared signal of the superficial cervical lymph node of dog 2 before (A) and during excision (B) under ambient light.

Figure 4

Photographs of the near infrared signal of the superficial brachial artery in (A) dog 1 and (B) dog 2 (under ambient light). In both pictures the yellow dashed line shows the theoretical anatomical landmarks of the flap, while the red dashed line shows the individual course of the vessel.