Intraoperative Use of Indocyanine Green Fluorescence Angiography during Distally Based Radial Artery Perforator Flap for Squamous Cell Carcinoma of the Thumb

Plastic and Reconstructive Surgery. Global Open
Ayato HayashiHiroshi Mizuno

Abstract

Distally based radial artery perforator flap (DBRAPF) is useful for hand defects; however, the location of the perforator varies among individuals. Preoperative evaluation has been a problematic issue when performing this flap. A 64-year-old man developed squamous cell carcinoma on an old burn scar at the dorsal thumb and was referred to our clinic for further treatment. After wide resection of the tumor, including the long and short extensors of the thumb, we reconstructed the defect with DBRAPF. At that time, near-infrared fluorescence angiography with indocyanine green (ICG) was used to identify the position of the perforator. After injecting ICG intravenously, we could observe its uptake at approximately 5 cm proximal to the styloid process. We designed a 10 × 6 cm island flap with that uptake as pivot point. During flap elevation, the perforator could be confirmed at the point of uptake; the flap was then transferred to the defect by rotating the pedicle at the identified point. The vascularity of the flap could also be checked intraoperatively through ICG angiography. The tip of the flap that showed weak ICG fluorescence indicated epidermal necrosis. Nevertheless, the entire flap was viable and enabled good functionality ...Continue Reading

References

Nov 1, 1995·Annals of Plastic Surgery·I KoshimaH Tanaka
Aug 14, 1998·Plastic and Reconstructive Surgery·S F Jeng, F C Wei
Oct 2, 2008·Plastic and Reconstructive Surgery·Ryuichi AzumaTomoharu Kiyosawa
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Feb 10, 2010·The Journal of Hand Surgery·Andrew M Ho, James Chang
Jul 1, 2011·Journal of Reconstructive Microsurgery·Daniel Z LiuPeter C Neligan

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Citations

Sep 10, 2016·Annales de chirurgie plastique et esthétique·C EchalierJ Pauchot
May 22, 2018·European Journal of Plastic Surgery·Anouk J M CornelissenRutger M Schols
Jun 15, 2017·Techniques in Hand & Upper Extremity Surgery·Paul A GhareebDiane E Payne

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biopsy

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