BACKGROUND: The decision to re-operate on a potentially ischemic free flap remains challenging. Indocyanine green videoangiography (ICG) with the FLOW® 800 tool is a method which allows an immediate qualitative conclusion about the patency of an anastomosis. Is it also able to predict the outcome of potentially compromised vascular free flaps? MATERIALS AND METHODS: An epigastric flap was raised and repositioned in 79 rats. Intraoperative fluorescence angiography was performed using ICG videoangiography and the FLOW® 800 tool was applied. Six regions of interest were positioned systematically over the flap, changes of the ICG fluorescence were color coded with respect to time and 474 measurements were performed. The flap was clinically monitored for one week and the resulting necrotic areas were correlated with the ICG/FLOW® 800 results. RESULTS: Mean intensity of clinically vital areas was 83.39 ± 50.96 arbitrary units (AU) and 37.33 ± 15.14 AU in necrotic areas. The receiver operating characteristic curve and Youden-Index analysis revealed that the optimal cutoff for the maximal intensity of ICG after FLOW® 800 analysis was ≤ 61.733 for the prediction of flap necrosis and > 61.733 for the prediction of flap survival (P < 0.0001; 95% CI = 0.85-0.91; Youden-Index: 0.67). The maximal intensity of ICG angiography had a specificity of 96.1% and sensitivity of 71.4%. The positive predictive value was 97.46% and the corresponding negative predictive value was 61.34%. CONCLUSION: This demonstrates the potential additional value of ICG videoangiography including FLOW® 800 analyses in the postoperative monitoring of transplanted flaps.
BACKGROUND: The decision to re-operate on a potentially ischemic free flap remains challenging. Indocyanine green videoangiography (ICG) with the FLOW® 800 tool is a method which allows an immediate qualitative conclusion about the patency of an anastomosis. Is it also able to predict the outcome of potentially compromised vascular free flaps? MATERIALS AND METHODS: An epigastric flap was raised and repositioned in 79 rats. Intraoperative fluorescence angiography was performed using ICG videoangiography and the FLOW® 800 tool was applied. Six regions of interest were positioned systematically over the flap, changes of the ICG fluorescence were color coded with respect to time and 474 measurements were performed. The flap was clinically monitored for one week and the resulting necrotic areas were correlated with the ICG/FLOW® 800 results. RESULTS: Mean intensity of clinically vital areas was 83.39 ± 50.96 arbitrary units (AU) and 37.33 ± 15.14 AU in necrotic areas. The receiver operating characteristic curve and Youden-Index analysis revealed that the optimal cutoff for the maximal intensity of ICG after FLOW® 800 analysis was ≤ 61.733 for the prediction of flap necrosis and > 61.733 for the prediction of flap survival (P < 0.0001; 95% CI = 0.85-0.91; Youden-Index: 0.67). The maximal intensity of ICG angiography had a specificity of 96.1% and sensitivity of 71.4%. The positive predictive value was 97.46% and the corresponding negative predictive value was 61.34%. CONCLUSION: This demonstrates the potential additional value of ICG videoangiography including FLOW® 800 analyses in the postoperative monitoring of transplanted flaps.
Authors: Melanie D Hicks; Alyssa K Ovaitt; Jason C Fleming; Anna G Sorace; Patrick N Song; Ameer Mansur; Yolanda E Hartman Bs; Eben L Rosenthal; Jason M Warram; Carissa M Thomas Journal: Head Neck Date: 2021-10-25 Impact factor: 3.147
Authors: Andreas M Fichter; Lucas M Ritschl; Luisa K Robitzky; Stefan Wagenpfeil; David A Mitchell; Klaus-Dietrich Wolff; Thomas Mücke Journal: Sci Rep Date: 2016-10-21 Impact factor: 4.379
Authors: Andreas M Fichter; Thomas Mücke; Lucas M Ritschl; Marie-Kristin Hofmann; Constantin T Wolff; Leonard H Schmidt; Klaus-Dietrich Wolff Journal: Sci Rep Date: 2021-04-22 Impact factor: 4.379
Authors: Andreas Hackethal; Markus Hirschburger; Sven Oliver Eicker; Thomas Mücke; Christoph Lindner; Olaf Buchweitz Journal: Geburtshilfe Frauenheilkd Date: 2018-01-22 Impact factor: 2.915
Authors: Thomas Mücke; Alexander Hapfelmeier; Leonard H Schmidt; Andreas M Fichter; Anastasios Kanatas; Klaus-Dietrich Wolff; Lucas M Ritschl Journal: Sci Rep Date: 2020-01-22 Impact factor: 4.379