PREOPERATIVE IDENTIFICATION OF PERFORATOR VESSELS IN FLAPS TO BE USED IN RECONSTRUCTIVE SURGERY
A method is disclosed for preoperative identification of a perforator vessel in a flap to be used in reconstructive surgery. The tissue area suitable for a flap is identified by injecting a bolus of ICG into the bloodstream, illuminating the tissue area with excitation light and observing ICG fluorescence through the skin. The location of the perforator vessel in the tissue area is marked on the patient's skin. An incision is made in the tissue area and the flap is harvested only after a suitable perforator vessel has been identified.
1 . A method for preoperative identification of a perforator vessel in a flap to be used in reconstructive surgery in a human patient using indocyanine green fluorescence angiography, comprising the steps of:
before making an incision in the human patient, locating a tissue area suitable for a flap;
injecting a bolus of indocyanine green into a bloodstream of the patient;
illuminating the tissue area with excitation light and observing indocyanine green fluorescence through the patient's skin; and
marking a location of the perforator vessel on the patient's skin in the tissue area based upon indocyanine green fluorescence, thereby improving surgical outcomes.
2 . The method of claim 1 , further comprising the steps of:
incising the tissue area comprising the perforator vessel whose location has been marked on the patient's skin;
harvesting the flap; and
transplanting the flap to a diseased or traumatized area to be reconstructed.
3 . The method of claim 2 , further comprising injecting a second bolus of indocyanine green intravenously into the bloodstream to evaluate perfusion of the perforator vessel in the harvested flap.
4 . The method of claim. 2 , and claim 3 , further comprising injecting a third bolus of indocyanine green into the bloodstream after transplanting to evaluate anastomotic patency and arterial and venous flow to prevent post-operative flap and graft failure.
5 . A method of assessing perfusion in a tissue flap used in reconstructive surgery in a patient, comprising the steps of:
incising a tissue area comprising at least one perforator vessel whose location has been confirmed using indocyanine green fluorescence angiography;
harvesting the tissue flap;
injecting a bolus of indocyanine green into a bloodstream of the patient;
illuminating the tissue area with excitation light and observing indocyanine green fluorescence through the patient's skin; and
assessing perfusion in the tissue flap on the basis of observed indocyanine green fluorescence, thereby improving surgical outcomes.