Use of fluorescent angiography to assess donor site perfusion prior to free tissue transfer.

OBJECTIVE To describe a novel use of fluorescent angiography in assessing donor limb perfusion prior to free tissue harvest in microvascular free tissue transfer. STUDY DESIGN Retrospective case series. METHODS From January 2012 to June 2013, 59 patients underwent head-and-neck microvascular free tissue reconstruction. Evaluation of donor site perfusion via indocyanine green (ICG) fluorescent angiography was utilized in 12 patients and 13 free flaps. Eleven cases were radial forearm free flaps (RFFF) and two were fibula free flaps (FFF). Preoperatively, RFFF patients were evaluated with Allen's testing, Doppler ultrasound, or both. FFF patients underwent magnetic resonance angiography. ICG was used intraoperatively to evaluate donor limb perfusion prior to free flap harvest. Intraoperative and postoperative complications of the donor limb were evaluated with cost analysis. RESULTS Average follow-up was 5.3 months. Preoperative Allen's testing was normal in six patients and ultrasound was performed in eight patients. One patient had a normal ultrasound, three showed minimal dampening, and four exhibited severe waveform flattening. There were no intraoperative complications using ICG. All 12 patients displayed adequate donor limb perfusion via fluorescent angiography. No digital or acute ischemic events were identified intraoperatively or postoperatively. There was no significant decrease in functionality or mobility of the donor limb. One patient noted mild arm pain with use. CONCLUSION Fluorescent angiography is another method to evaluate donor site perfusion prior to free tissue harvest. Larger prospective analysis would be helpful to more thoroughly evaluate safety, although this is limited by the overall low risk of ischemic complications. LEVEL OF EVIDENCE 4.