Assessment of Fibula Flap Skin Perfusion in Patients Undergoing Oromandibular Reconstruction: Comparison of Clinical Findings, Fluorescein, and Indocyanine Green Angiography

JAMA Facial Plastic Surgery
Andrew D BecklerKeith E Blackwell

Abstract

Complications of partial flap necrosis contribute substantially to morbidity in patients who undergo head and neck reconstructive surgery. To assess the usefulness of clinical findings, intraoperative fluorescein angiography, and intraoperative indocyanine green angiography (ICGA) for evaluation of flap skin paddle perfusion in patients undergoing oromandibular reconstruction who are at high risk of partial skin paddle necrosis. Retrospective medical record review from May 21, 1996, to May 27, 2015, at a tertiary care academic medical center. Participants were 73 patients who underwent reconstruction of through-and-through defects of the mucosa, mandible, and skin using fibula free flaps that contained large bilobed skin paddles. The rates of partial skin paddle necrosis and revision reconstructive surgery. The rates of partial flap necrosis were 8% (n = 2) among 25 patients in whom the skin paddle was trimmed based on ICGA and 33% (n = 16) among 48 patients in whom the skin paddle was trimmed according to clinical findings (P = .02). The rates of revision reconstructive surgery were 20% (5 of 25) when flap skin paddles were trimmed using ICGA and 42% (20 of 48) when trimmed per clinical findings (P = .06). The use of ICGA may ...Continue Reading

References

Oct 1, 1990·American Journal of Surgery·J P ShahP Sutaria
Oct 1, 1989·Archives of Otolaryngology--head & Neck Surgery·C W CummingsM D Coltrera
Feb 9, 1999·Plastic and Reconstructive Surgery·B SinghJ P Shah
Aug 18, 2004·Archives of Otolaryngology--head & Neck Surgery·Jeffrey D SuhKeith E Blackwell
Nov 3, 2005·Head & Neck·Brian A MooreJames L Netterville
Jan 23, 2009·Annals of Plastic Surgery·William G AustenJoseph Upton
May 1, 2012·Plastic and Reconstructive Surgery·Hunter R Moyer, Albert Losken
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Jan 8, 2014·Aesthetic Surgery Journal·Claire S DuggalAlbert Losken

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Citations

Feb 6, 2018·Clinical Hemorheology and Microcirculation·Jan NeumannMoritz Wildgruber
Sep 4, 2015·JAMA Facial Plastic Surgery·Yadranko Ducic
Jan 17, 2020·Plastic and Reconstructive Surgery. Global Open·Daniel P ButlerNavid Jallali
Feb 23, 2021·Craniomaxillofacial Trauma & Reconstruction·Anthony MassaroRui Fernandes
Jul 16, 2021·Acta otorhinolaryngologica Italica : organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale·Axel SahovalerKevin Higgins

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