Diluted Indocyanine Green Angiography: A Novel Approach to Free Flap Perfusion Evaluation in Reconstructive Microsurgery
Background:. Assessing perfusion in free flaps is crucial in clinical practice. Indocyanine green (ICG) angiography offers a more objective and reproducible method, utilizing near-infrared imaging to monitor flap vascularization. This study aims to evaluate the efficacy of diluted ICG as a tool for...
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| Language: | English |
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Wolters Kluwer
2024-11-01
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| Series: | Plastic and Reconstructive Surgery, Global Open |
| Online Access: | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000006280 |
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| author | Parintosa Atmodiwirjo, MD Mohamad Rachadian Ramadan, MD Aditya Wicaksana, MD Michael Djohan, MD Nadira Fildza Amanda, MD Nadhira Anindita Ralena, MD Ismail Hadisoebroto Dilogo, MD, PhD Purnomo Sidi Priambodo, MSc, PhD Retno Asti Werdhani, MD, PhD Em Yunir, MD, PhD Lisnawati Rachmadi, MD, PhD Alida Roswita Harahap, MD, PhD Prasandhya Astagiri Yusuf, PhD Lisa Hasibuan, MD, PhD Daisuke Mito, MD |
| author_facet | Parintosa Atmodiwirjo, MD Mohamad Rachadian Ramadan, MD Aditya Wicaksana, MD Michael Djohan, MD Nadira Fildza Amanda, MD Nadhira Anindita Ralena, MD Ismail Hadisoebroto Dilogo, MD, PhD Purnomo Sidi Priambodo, MSc, PhD Retno Asti Werdhani, MD, PhD Em Yunir, MD, PhD Lisnawati Rachmadi, MD, PhD Alida Roswita Harahap, MD, PhD Prasandhya Astagiri Yusuf, PhD Lisa Hasibuan, MD, PhD Daisuke Mito, MD |
| author_sort | Parintosa Atmodiwirjo, MD |
| collection | DOAJ |
| description | Background:. Assessing perfusion in free flaps is crucial in clinical practice. Indocyanine green (ICG) angiography offers a more objective and reproducible method, utilizing near-infrared imaging to monitor flap vascularization. This study aims to evaluate the efficacy of diluted ICG as a tool for assessing free flap perfusion.
Methods:. This pilot randomized clinical trial compares the fluorescence concentrations of ICG at 3 different dilutions: 5 mg/mL (standard concentration), 2.5 mg/mL (half the standard concentration), and 0.5 mg/mL (one-tenth of the standard concentration). Inclusion criteria required participants to have serum albumin levels above 3 g/dL, hemoglobin levels over 10 g/dL, and no comorbidities. Participants were randomized into 3 groups based on ICG concentration. Fluorescence analysis was performed using ImageJ software to determine mean gray values. Both surgeons and data analysts were blinded to the ICG concentrations administered, ensuring unbiased evaluation.
Results:. Forty-five patients undergoing free flap surgery, predominantly male (60%) with a mean age of 37.76 ± 19.79 years and a mean body mass index of 21.23 ± 4.49 kg/m², primarily received osteoseptocutaneous fibular free flaps (46.67%), with an average skin flap area of 66.07 ± 46.94 cm². The primary etiology was underlying tumors (84.4%), with the head and neck as the most common reconstruction site (82.2%). The superior thyroid artery was the most frequently used recipient vessel (37.78%). Analysis revealed mean gray values of 64.10 ± 8.27 (5 mg/mL), 79.03 ± 2.7 (2.5 mg/mL), and 33.56 ± 3.47 (0.5 mg/mL), with 2.5 mg/mL yielding the highest value (P < 0.001).
Conclusions:. Findings suggest using 2.5 mg/mL concentration enhances fluorescence emission, offering a dosage alternative in clinical practice. |
| format | Article |
| id | doaj-art-db4745dec75c44619d1ac7ad3d6c9005 |
| institution | Kabale University |
| issn | 2169-7574 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Wolters Kluwer |
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| series | Plastic and Reconstructive Surgery, Global Open |
| spelling | doaj-art-db4745dec75c44619d1ac7ad3d6c90052024-11-26T08:02:35ZengWolters KluwerPlastic and Reconstructive Surgery, Global Open2169-75742024-11-011211e628010.1097/GOX.0000000000006280202411000-00008Diluted Indocyanine Green Angiography: A Novel Approach to Free Flap Perfusion Evaluation in Reconstructive MicrosurgeryParintosa Atmodiwirjo, MD0Mohamad Rachadian Ramadan, MD1Aditya Wicaksana, MD2Michael Djohan, MD3Nadira Fildza Amanda, MD4Nadhira Anindita Ralena, MD5Ismail Hadisoebroto Dilogo, MD, PhD6Purnomo Sidi Priambodo, MSc, PhD7Retno Asti Werdhani, MD, PhD8Em Yunir, MD, PhD9Lisnawati Rachmadi, MD, PhD10Alida Roswita Harahap, MD, PhD11Prasandhya Astagiri Yusuf, PhD12Lisa Hasibuan, MD, PhD13Daisuke Mito, MD14From the * Reconstructive Microsurgery and Oncoplasty Section, Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, Dr. Cipto Mangunkusumo National Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, IndonesiaFrom the * Reconstructive Microsurgery and Oncoplasty Section, Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, Dr. Cipto Mangunkusumo National Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, IndonesiaFrom the * Reconstructive Microsurgery and Oncoplasty Section, Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, Dr. Cipto Mangunkusumo National Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, IndonesiaFrom the * Reconstructive Microsurgery and Oncoplasty Section, Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, Dr. Cipto Mangunkusumo National Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, IndonesiaFrom the * Reconstructive Microsurgery and Oncoplasty Section, Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, Dr. Cipto Mangunkusumo National Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, IndonesiaFrom the * Reconstructive Microsurgery and Oncoplasty Section, Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, Dr. Cipto Mangunkusumo National Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia† Doctoral Program in Medical Sciences, Department of Orthopedic and Traumatology, Dr. Cipto Mangunkusumo National Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia‡ Department of Electrical Engineering, Faculty of Engineering, Universitas Indonesia, Depok, Indonesia§ Department of Community Medicine, Dr. Cipto Mangunkusumo National Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia¶ Division of Endocrinology, Metabolic Disease, and Diabetes, Department of Internal Medicine, Dr. Cipto Mangunkusumo National Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia∥ Department of Pathological Anatomy, Dr. Cipto Mangunkusumo National Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia** Department of Clinical Pathology, Dr. Cipto Mangunkusumo National Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia†† Department of Medical Physiology and Biophysics/Medical Technology IMERI, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia‡‡ Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia§§ Trauma and Reconstruction Center, Teikyo University Hospital, Tokyo, Japan.Background:. Assessing perfusion in free flaps is crucial in clinical practice. Indocyanine green (ICG) angiography offers a more objective and reproducible method, utilizing near-infrared imaging to monitor flap vascularization. This study aims to evaluate the efficacy of diluted ICG as a tool for assessing free flap perfusion. Methods:. This pilot randomized clinical trial compares the fluorescence concentrations of ICG at 3 different dilutions: 5 mg/mL (standard concentration), 2.5 mg/mL (half the standard concentration), and 0.5 mg/mL (one-tenth of the standard concentration). Inclusion criteria required participants to have serum albumin levels above 3 g/dL, hemoglobin levels over 10 g/dL, and no comorbidities. Participants were randomized into 3 groups based on ICG concentration. Fluorescence analysis was performed using ImageJ software to determine mean gray values. Both surgeons and data analysts were blinded to the ICG concentrations administered, ensuring unbiased evaluation. Results:. Forty-five patients undergoing free flap surgery, predominantly male (60%) with a mean age of 37.76 ± 19.79 years and a mean body mass index of 21.23 ± 4.49 kg/m², primarily received osteoseptocutaneous fibular free flaps (46.67%), with an average skin flap area of 66.07 ± 46.94 cm². The primary etiology was underlying tumors (84.4%), with the head and neck as the most common reconstruction site (82.2%). The superior thyroid artery was the most frequently used recipient vessel (37.78%). Analysis revealed mean gray values of 64.10 ± 8.27 (5 mg/mL), 79.03 ± 2.7 (2.5 mg/mL), and 33.56 ± 3.47 (0.5 mg/mL), with 2.5 mg/mL yielding the highest value (P < 0.001). Conclusions:. Findings suggest using 2.5 mg/mL concentration enhances fluorescence emission, offering a dosage alternative in clinical practice.http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000006280 |
| spellingShingle | Parintosa Atmodiwirjo, MD Mohamad Rachadian Ramadan, MD Aditya Wicaksana, MD Michael Djohan, MD Nadira Fildza Amanda, MD Nadhira Anindita Ralena, MD Ismail Hadisoebroto Dilogo, MD, PhD Purnomo Sidi Priambodo, MSc, PhD Retno Asti Werdhani, MD, PhD Em Yunir, MD, PhD Lisnawati Rachmadi, MD, PhD Alida Roswita Harahap, MD, PhD Prasandhya Astagiri Yusuf, PhD Lisa Hasibuan, MD, PhD Daisuke Mito, MD Diluted Indocyanine Green Angiography: A Novel Approach to Free Flap Perfusion Evaluation in Reconstructive Microsurgery Plastic and Reconstructive Surgery, Global Open |
| title | Diluted Indocyanine Green Angiography: A Novel Approach to Free Flap Perfusion Evaluation in Reconstructive Microsurgery |
| title_full | Diluted Indocyanine Green Angiography: A Novel Approach to Free Flap Perfusion Evaluation in Reconstructive Microsurgery |
| title_fullStr | Diluted Indocyanine Green Angiography: A Novel Approach to Free Flap Perfusion Evaluation in Reconstructive Microsurgery |
| title_full_unstemmed | Diluted Indocyanine Green Angiography: A Novel Approach to Free Flap Perfusion Evaluation in Reconstructive Microsurgery |
| title_short | Diluted Indocyanine Green Angiography: A Novel Approach to Free Flap Perfusion Evaluation in Reconstructive Microsurgery |
| title_sort | diluted indocyanine green angiography a novel approach to free flap perfusion evaluation in reconstructive microsurgery |
| url | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000006280 |
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