Plastic Surgery Research Council
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Presenter: Mitchell S Fourman, MPhil
Co-Authors: Nasser A; Mathison M; Phillips BT; Gersch R; Gelfand M; Bui DT
Stony Brook University Medical Center

Background: The integrity and patency of the vascular anastomosis is critical to successful flap-based reconstruction. Failure to ensure adequate blood flow can result in flap necrosis, necessitating surgical revision. Prior findings suggest that LAICGA has significant potential for making dynamic measurements of blood flow. Here we describe a novel methodology to predict the development of venous stasis within a simulated flap anastomosis by using comparative time-dependent LAICGA perfusion measurements.

Methods: Eight Male Fisher rats had both femoral vessels visualized immediately distal to the inguinal ligament. The femoral vein on one side was dissected and ligated using a single 4-0 polypropylene suture. Immediately following ligation .04 cc of 2.5 mg/mL Indocyanine Green (ICG) was injected into the external jugular vein via venous catheter. LAICGA was simultaneously performed on both legs using LifeCell SPY-Elite (Branchburg, NJ) centered at the pubic symphysis. The perfusion of standardized anatomic points in both feet was recorded using the SPY-Q analysis program, with the perfusion of the unligated femoral vein defined as 100%.

Results: ICG perfusion is characterized by a 60 second arterial phase of rapid signal decay, followed by a stable venous phase. A statistically significant difference in foot perfusion was found to coincide with the start of the venous phase (p = .036), with the ligated feet (73.83 +- 1.17% of normal) fluorescing more intensely than controls (57.33 +- 3.0% of normal). This significance was found to persist for 5 minutes following dye injection.

Conclusion: This is the first demonstration to our knowledge of a minimally invasive methodology to diagnose acute venous stasis in flap anastomoses. Data indicates that indocyanine green angiography presents a low risk and minimally invasive option to obtain consistent and reliable information about the venous drainage of a vascular pedicle. Future work will attempt to demarcate the limits of this finding in variants of this model that simulate gradual and partially occluded vessels, as well as in previously validated porcine flap models.

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