Indocyanine Green SPY Intraoperative Perfusion Assessment System Use In Flap Surgery

Objective:In the reconstruction surgery,Indocyanine green SPY Intraoperative Perfusion Assessment System can be used to assess the real-time blood perfusion of all kinds of flaps,to predict the prognosis of the flaps.In our study,we will introduce the use of SPY system to evaluate the flap perfusion,and retrospectively analyze the postoperative survival of flaps,and summarize the effectiveness efficacy of indocyanine green SPY Intraoperative Perfusion Assessment System in flap surgery.Methods:Between July of 2016 and March of 2017,45 flaps of 35 consecutive patients were retrospectively analyzed.There were 23 male and 12 female.The Patients’ age ranged from 2 to 69 years(mean,17.8 years).Among the 45 flaps,44 were pedicle flaps and 1 was free flap,measuring 2 × 1.5 cm～34 × 17 cm.The free flap is 1 case of free latissimus dorsi muscle flap.The 44 pedicle flaps are included 11 cases of trapezius myocutaneous flap,11 cases of perforator flap,5 cases of forehead flap,5 cases of medial upper arm flap,4 cases of latissimus dorsi muscle flap,3 cases of parumbilical skin flap,2 cases of anterolateral femoral flap,2 cases of scapular flap,1 cases of medial plantar flap.The ICG fluorescein angiography was performed twice for each flap,after the elevation of flap and after flap insertion respectively.The correlation of the flap perfusion detected by SPY System and the prognosis of each flap were recorded and analyzed.Results:29 flaps demonstrated good perfusion by SPY System healed uneventfully.16 flaps were demonstrated poor perfusion in the distal part of flap.Two flaps underwent surgical intervention intraoperatively and totally survived.14 flaps were preserved conservatively and nine suffered partial-or full-thickness necrosis.None of the remaining five flaps sustained necrosis.Secondary healing was achieved through regular dressing change or operative debridement.The sensitivity,specificity and accuracy were 100%,85.3%and 88.4%respectively.Conclusion:Our study confirmed indocyanine green SPY Intraoperative Perfusion Assessment System can be used to evaluate the real-time intraoperative perfusion of various types of flaps with high sensitivity and specificity of flap perfusion assessment.The SPY System provides an objective and effective means for predicting skin flap necrosis for surgeons.