Clinical effect of indocyanine green angiography-assisted design and harvest of expanded flaps for scar reconstruction

Hu Yanan; Xie Tingjun; Liu Yuanbo; Zhu Shan; Yang Zengjie; Tian Jia; Gan Cheng; Jiao Hu; Li Shanshan; Chen Zixiang; Zhou Lu; Han Bing; Jin Shengyang; Zeng Yan; Wang Miao; Zang Mengqing

doi:10.3760/cma.j.cn501225-20250108-00013

Volume 41 Issue 4

Apr. 2025

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Article Navigation > CHINESE JOURNAL OF BURNS AND WOUNDS > 2025 > 41(4): 341-347

Hu YN,Xie TJ,Liu YB,et al.Clinical effect of indocyanine green angiography-assisted design and harvest of expanded flaps for scar reconstruction[J].Chin J Burns Wounds,2025,41(4):341-347.DOI: 10.3760/cma.j.cn501225-20250108-00013.

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Clinical effect of indocyanine green angiography-assisted design and harvest of expanded flaps for scar reconstruction

doi: 10.3760/cma.j.cn501225-20250108-00013

Scar and Wound Treatment Center, Plastic Surgery Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100144, China

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Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences 2023-I2M-C&T-B-104

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Corresponding author: Zang Mengqing, Email: zangmengqing@sina.com
Received Date: 2025-01-08

Abstract

Abstract

Objective To investigate the clinical effect of indocyanine green angiography (ICGA)-assisted design and harvest of expanded flaps for scar reconstruction. Methods This study was a retrospective observational study. From April 2019 to August 2023, 19 patients with scars (8 males, 11 females; aged 3-38 years) treated at the Plastic Surgery Hospital of Peking Union Medical College and Chinese Academy of Medical Sciences met the inclusion criteria. The scars were distributed on the head, face, trunk, and extremities. In stage Ⅰ surgery, skin soft tissue expanders were implanted in suitable areas around the scars for skin soft tissue expansion. In stage Ⅱ surgery, the scar tissue was excised, resulting in wound areas ranging from 100 to 210 cm², and expanded flaps were designed. ICGA was used to identify target perforators and their accompanying veins, and the flap design was adjusted to ensure the inclusion of complete arterial and venous axes. The expanded flap with an area of 120 to 240 cm² was harvested using unilateral back-cut technique and transferred to the recipient site, and the donor site wound was sutured directly. The durations of the arterial and venous phases of ICGA during flap design were recorded. The length-to-width ratios of the back-cut flaps were calculated for different regions. After stage Ⅱ surgery, the blood perfusion and survival of the flap, the wound healing at the donor site, and the occurrence of complications were observed. During follow-up, the appearance, color, and texture of the patient's flap were observed. Results The arterial phase of ICGA lasted 10-27 (18±5) s, and the venous phase lasted 78-116 (100±10) s. The length-to-width ratios of the back-cut flaps were 1.22±0.32, 1.63±0.12, and 1.15±0.21 for the head and neck, trunk, and limb regions, respectively. After stage Ⅱ surgery, one patient had a large area of insufficient blood perfusion in the flap. By comparing ICGA images before and after flap transfer, the sutures at the oral commissure were loosened, the blood flow of the flap was restored. The blood perfusion of the flaps in other patients was good. All flaps survived completely, with well-healed donor site wounds and no complications. During 0.5-14.0 months of follow-up, all flaps of patients demonstrated excellent appearance, with color and texture matching the surrounding skin. Conclusions As a means of superficial blood flow visualization, ICGA can not only clearly show the microvascular distribution of the expanded flap before operation, assist in optimizing the design of the flap, but also evaluate the blood perfusion of the flap after operation, reduce the occurrence of complications, and provide a full-process navigation for the harvesting of expanded flaps, thereby improving the safety of flap transfer for scar reconstruction.
- Cicatrix,
- Angiography,
- Perforator flap,
- Indocyanine green angiography,
- Skin and soft tissue expansion,
- Flap design,
- Wound repair

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References(35)

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