JPRAS open · 2026
Exploring perfusion limits in pedicled perforator propeller flaps via intraoperative indocyanine green angiography.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Sebald Adrian, Ludolph Ingo, Mundschau Corinna, Arkudas Andreas, Horch Raymund E
Аннотация
BACKGROUND: Pedicled perforator propeller flaps are widely used for soft-tissue reconstruction because they preserve donor-site function while providing reliable defect coverage. However, intraoperative assessment of flap perfusion remains challenging, particularly in longer flaps or after axial rotation. Indocyanine green (ICG) fluorescence angiography allows real-time visualization of tissue perfusion and may improve intraoperative decision-making.
METHODS: A retrospective single-center study was performed including 30 patients who underwent reconstruction with pedicled perforator propeller flaps between 2014 and 2022. Intraoperative ICG angiography was performed using the SPY-Elite system after flap elevation and after inset. A total of 48 angiographic sequences were analyzed using ImageJ software. Fluorescence intensity, perfusion distribution, and contour levels (20% and 30%) were evaluated across standardized 3-cm flap segments from the perforator origin to the distal flap edge.
RESULTS: All flaps survived, resulting in a flap survival rate of 100%. Postoperative complications occurred in 6 patients (20%), including 3 cases of minor wound-healing disorders and 3 cases of venous congestion requiring revision. Mean flap length was 15.8 cm. The average perfused area at the 20% fluorescence contour level represented 97.2% of the total flap surface. Perfusion decreased progressively with increasing distance from the perforator and declined significantly in flaps exceeding 15 cm in length (p < 0.01). Flaps shorter than 10 cm demonstrated homogeneous perfusion across all segments. Lower extremity flaps showed more consistent perfusion patterns compared with truncal and gluteal flaps.
CONCLUSIONS: Intraoperative ICG fluorescence angiography provides a reliable method for assessing perfusion in pedicled perforator propeller flaps. Perfusion mapping suggests that flap lengths under 10 cm and tissue areas within the 20%-30% fluorescence contour levels are associated with consistent viability. ICG angiography may therefore serve as a useful adjunct to optimize flap design and enhance surgical safety in reconstructive procedures.
METHODS: A retrospective single-center study was performed including 30 patients who underwent reconstruction with pedicled perforator propeller flaps between 2014 and 2022. Intraoperative ICG angiography was performed using the SPY-Elite system after flap elevation and after inset. A total of 48 angiographic sequences were analyzed using ImageJ software. Fluorescence intensity, perfusion distribution, and contour levels (20% and 30%) were evaluated across standardized 3-cm flap segments from the perforator origin to the distal flap edge.
RESULTS: All flaps survived, resulting in a flap survival rate of 100%. Postoperative complications occurred in 6 patients (20%), including 3 cases of minor wound-healing disorders and 3 cases of venous congestion requiring revision. Mean flap length was 15.8 cm. The average perfused area at the 20% fluorescence contour level represented 97.2% of the total flap surface. Perfusion decreased progressively with increasing distance from the perforator and declined significantly in flaps exceeding 15 cm in length (p < 0.01). Flaps shorter than 10 cm demonstrated homogeneous perfusion across all segments. Lower extremity flaps showed more consistent perfusion patterns compared with truncal and gluteal flaps.
CONCLUSIONS: Intraoperative ICG fluorescence angiography provides a reliable method for assessing perfusion in pedicled perforator propeller flaps. Perfusion mapping suggests that flap lengths under 10 cm and tissue areas within the 20%-30% fluorescence contour levels are associated with consistent viability. ICG angiography may therefore serve as a useful adjunct to optimize flap design and enhance surgical safety in reconstructive procedures.