Abstract
Introduction
Free flaps are routinely used in head and neck surgery for reconstruction after major ablative procedures. Among these, radial forearm free flap (RFFF) still represents a workhorse. Regarding its harvesting, donor site complications are described, with acute hand ischemia as the most feared one. To evaluate residual hand perfusion through the ulnar axis, several methods are commonly used in clinical practice, such as the modified Allen’s test (MAT) and Doppler ultrasound. Nevertheless, contradictory results are not uncommon. Indocyanine green (ICG) fluorescence video-angiography (ICG-VA) is a technique recently introduced in flap surgery to evaluate tissue perfusion, which may be employed during RFFF harvesting to enhance the accuracy of the traditional tests.
Patients and Methods
To assess the dual blood supply in the donor site prior to harvesting a RFFF, we performed MAT, Doppler ultrasound, and ICG-VA in a patient suffering from oropharyngeal cancer who underwent major ablative and reconstructive surgery. The technique is described in the Video.
Results
Clinical MAT was judged as “positive,” highlighting an adequate dual blood supply to the hand, and the upper limb Doppler ultrasound showed a normal blood flow. Similarly, also ICG-VA pointed out a good hand perfusion pattern with a thenar-to-hypothenar ICG ratio of over 25%. Thus, we proceeded with RFFF harvesting without evidence of ischemic complications at the donor site in the postoperative course.
Conclusions
ICG-VA represents a safe and useful procedure to reduce donor site morbidity during RFFF harvesting, enhancing the sensitivity of the clinical MAT, and potentially detecting its (rare) false positive results.
Level of Evidence: Level V.
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All authors contributed to the study’s conception and design. Material preparation, data collection, and analysis were performed by Leone Giordano, Andrea Galli, Marco Familiari, and Ayhan Irem. The first draft of the manuscript was written by Leone Giordano, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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The study was conducted according to the ethical standards established in the 1964 Declaration of Helsinki and revised in 2008. The present protocol was approved by our Institutional Review Board (protocol number: 181/INT/2021; approval date: 15/12/2021).
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Informed consent was obtained from the patient included in the study.
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Giordano, L., Familiari, M., Irem, A. et al. How to Enhance the Accuracy of the Allen’s Test with Indocyanine Green Fluorescence Video-Angiography. Indian J Surg 85, 1242–1244 (2023). https://doi.org/10.1007/s12262-023-03672-9
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DOI: https://doi.org/10.1007/s12262-023-03672-9