Application of highly selective arterial indocyanine green angiography in the design of anterolateral thigh free flap

Wang Shi; Dong Shuai; Cao Yang; Wang Guiyang; Yang Chengpeng; Sun Fengwen; Huang Yongtao; Guo Liping; Yang Liang; Zhou Rong; Ju Jihui

doi:10.3760/cma.j.cn501225-20240513-00174

Volume 40 Issue 10

Oct. 2024

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Article Navigation > CHINESE JOURNAL OF BURNS AND WOUNDS > 2024 > 40(10): 948-954

Wang S,Dong S,Cao Y,et al.Application of highly selective arterial indocyanine green angiography in the design of anterolateral thigh free flap[J].Chin J Burns Wounds,2024,40(10):948-954.DOI: 10.3760/cma.j.cn501225-20240513-00174.

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Application of highly selective arterial indocyanine green angiography in the design of anterolateral thigh free flap

doi: 10.3760/cma.j.cn501225-20240513-00174

1.
Department of Hand Surgery, Suzhou Ruihua Orthopaedic Hospital, Suzhou 215104, China
2.
Department of Wound Repair Surgery, Suzhou Ruihua Orthopaedic Hospital, Suzhou 215104, China

Funds:

Suzhou Key Medical Discipline SZXK202127

Suzhou Science and Technology Development Plan SKYD2023026

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Corresponding author: Ju Jihui, Email: gkswk2013@163.com
Received Date: 2024-05-13

Abstract

Abstract

Objective To introduce the application of highly selective arterial indocyanine green angiography (hereinafter referred to as highly selective arterial angiography) in the design of anterolateral thigh free flap. Methods This study was a retrospective observational study. From November 2023 to April 2024, 29 patients with wounds in extremities which were repaired by anterolateral thigh free flaps designed under the assistance of highly selective arterial angiography and met the inclusion criteria were admitted to the Department of Hand Surgery and Department of Wound Repair Surgery of Suzhou Ruihua Orthopedic Hospital, including 26 males and 3 females, aged 16 to 71 years. The wound area after debridement ranged from 8.0 cm×4.5 cm to 27.0 cm×16.0 cm. During the surgery, highly selective arterial angiography was used to assist in flap design. The fluorescence development range of the source arteries or perforators of flaps was observed. The blood supply range of the source arteries or perforators of flaps was determined based on the fluorescence development of the skin, and the excision position of the flap was adjusted. The flap incision area ranged from 9.0 cm×6.0 cm to 29.0 cm×16.0 cm. During the surgery, the number of highly selective arterial angiography, the type of source artery of perforators for puncture, and changes in the excision position of flaps were observed and recorded. After surgery, the blood supply and survival of flaps, the healing of wounds and the survival of skin grafts in the flap donor sites, and the angiography-related complications were observed. Results All the 32 flaps of 29 patients were successfully excised. The highly selective arterial angiography was performed 37 times, including 13 cases of puncture of the oblique branch of the lateral circumflex femoral artery, 6 cases of puncture of the descending branch, 8 cases of double puncture of the oblique and descending branches, and 2 cases of puncture of arteries from other branches. During the surgery, the excision position of 28 flaps did not change, the excision position of 3 flaps moved towards proximal extremity of the thigh, and the excision position of 1 flap moved towards distal extremity of the thigh. All the flaps survived successfully after the surgery, and there was no partial necrosis of the flaps at the proximal or distal ends. The wounds in the flap donor sites healed, and all skin grafts survived. No angiography-related complications occurred. Conclusions Highly selective arterial angiography can be used to determine the blood supply range of the source artery and perforators of the anterolateral thigh free flaps during the surgery. It can evaluate the blood supply of flaps more intuitively and objectively. Its application in assisting flap design can avoid partial flap necrosis caused by unreasonable preoperative design to a certain extent, and it is safe and reliable.
- Angiography,
- Surgical flaps,
- Perforator flap,
- Indocyanine green,
- Arteriography,
- Anterolateral thigh flap,
- Lateral circumflex femoral artery,
- Wound repair

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References

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