Indocyanine Green Angiography Enhances Free Flap Surgery Outcomes

In a recent study, a team led by Sunil Choudhary aimed to explore the potential benefits of Indocyanine Green Angiography (ICGA) in free flap surgeries. The findings were published in the Indian Journal of Plastic Surgery.

Free flap surgery, a complex reconstructive procedure involving the transfer of tissue from one part of the body to another, is often used in cases of trauma, cancer, and congenital anomalies. However, flap failure due to insufficient blood supply can be a major concern, leading to partial flap loss and the need for re-exploration, both of which can significantly impact patient recovery and increase healthcare costs.

The study, conducted over a period of 12 years and comprising 877 consecutive free flaps, sought to assess and validate the role of ICGA in improving surgical outcomes and its cost-effectiveness. Additionally, the researchers introduced a new intraoperative protocol known as whole-body surface warming (WBSW) during strategic "microbreaks" to further enhance flap success rates.

The ICGA group, consisting of 438 patients, was compared to the historical No-ICGA group, comprising 439 patients, to evaluate the impact of ICGA on flap-related adverse outcomes. Statistical analysis revealed that the use of ICGA resulted in a significant reduction in partial flap loss and re-exploration rates when compared to the No-ICGA group.

Moreover, the study found that ICGA was a cost-effective tool in free flap surgeries, providing valuable real-time information on flap perfusion and enabling surgeons to make well-informed decisions during the procedure. By identifying potential problem areas early, surgeons could take corrective measures, thus reducing the need for re-exploration and minimizing the associated costs.

Furthermore, the researchers introduced the innovative concept of whole-body surface warming (WBSW) during "microbreaks" in the surgical process. This new protocol was shown to have a positive impact on flap perfusion. By optimizing blood flow to the flap during critical moments, WBSW increased the chances of flap success and further improved patient outcomes.

As a result of these findings, the study strongly recommends the integration of ICGA into the intraoperative assessment of flap perfusion in free flap surgeries.

Reference:

Choudhary, S., Khanna, S., Mantri, R., & Arora, P. (2023). Role of Indocyanine Green Angiography in Free Flap Surgery: A Comparative Outcome Analysis of a Single-Center Large Series of 877 Consecutive Free Flaps. In Indian Journal of Plastic Surgery (Vol. 56, Issue 03, pp. 208–217). Georg Thieme Verlag KG. https://doi.org/10.1055/s-0043-57270