Clinical Application Of Indocyanine Green Video Angiography And Color Doppler Ultrasound In The Preoperative Blood Vessel Positioning Of Perforator Flap

Objective:To compare the accuracy of indocyanine green video angiography and color Doppler ultrasound in the preoperative localization of the perforator vessels, to explore the advantages and disadvantages of indocyanine green video angiography and color Doppler ultrasound, and their application value in perforator flap surgery.Methods:From October 2014 to April 2016, in the Department of Orthopaedics, Kunming General Hospital of Chengdu Military Command,26 cases of perforator flap surgery were included. All patients were used color doppler ultrasound and indocyanine green video angiography for positioning the perforator vessels in donor site before the operation. Of all the perforator flaps the peroneal artery perforator flap were 12 cases, the lateral circumflex femoral artery perforator flap were 14 cases. During the operation the marked vessels inside the flap-harvest territory were explored to analyse the perforator detecting accuracy by the two positioning methods. The largest area of flap was 20 cmx 16 cm and minimum flap was 7 cm× 3 cm, the fine diameter of perforator vessel was 0.5 mm, the maximum was 1.8 mm,repairing parts:the hand and forearm wounds were 9 cases, the ankle wounds were 17 cases.Results:All flaps survived after the operation. Sixteen cases of the donor site were directly closed,while partial donor site skin grafting needed in 10 cases.After operation, Eighteen cases were followed up for 3 to 9 months postoperativly. The texture of the flap was good, and the donor site healed well.In flap resection range, the 12 cases of peroneal artery perforator flap, preoperative examination by CDUS revealed 24 perforators, preoperative application by ICGVA found 25 perforators, confirmed in the operation were 26 perforators;the 14 cases of lateral circumflex femoral artery perforator flap, preoperative examination by CDUS revealed 39 perforators, preoperative application by ICGVA found 32 perforators, confirmed in the operation were 36 perforators. The accuracy rate of peroneal artery perforator flap were CDUS 92.31%, ICGVA 96.15%(t=0.36, p=1.00>0.05), there had no statistically difference with CDUS and ICGVA. The accuracy rate of lateral circumflex femoral artery perforator flap were CDUS 92.31%, ICGVA 88.89%(t=0.36, p=1.00>0.05), there had no statistically difference with CDUS and ICGVA.Conclusion:1.The methods of perforator localization preoperativly by indocyanine green video angiography and color Doppler ultrasound are accurate, true and reliable. 2.Color Doppler ultrasound can explore perforating vessel origin, blood vessel diameter, blood flow parameters, but has the disadvantage of false positive and false negative, and requires experienced technicians.3.Indocyanine green video angiography is a surface-positioning method, and possesses the advantage of rapid and accurate positioning, of reflecting the perforator vessel perfusion range. Indocyanine green video angiography can be conducted by the operator himself. But as a kind of surface imaging technology, it can not reflect the deep shape and adjacent to the source artery.