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The success or failure of a reconstruction is largely related to the vascularization of the operated area. Near infrared fluorescence (also near infrared fluorescence angiography, NIR FA) with ICG administration is an innovative technique to quantify tissue perfusion. Based on the results obtained in other subspecialties, NIR fluorescence appears to be a promising way to quantify tissue perfusion in reconstructive surgery. Fluorescence research has previously been used in the context of microsurgery and breast reconstructions using implants, but structural objective determinations are lacking. Our study is successful if we are able to determine a cut off value for the absolute or relative perfusion parameters.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Debridement after radiotherapy | Debridement after radiotherapy |
| |
| Debridement after trauma | Debridement after trauma |
| |
| Reconstructive surgery using a fasciocutaneous flap | Reconstructive surgery using a fasciocutaneous flap |
| |
| Reconstructive surgery using a muscle flap | Reconstructive surgery using a muscle flap |
| |
| Reconstructive surgery using a osseous flap | Reconstructive surgery using a osseous flap |
| |
| Vaginaplasties | Vaginaplasties using a peritoneum flap or colon interposition |
| |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Indocyanine green | Drug | Administration of ICG during surgery and recording of the fluorescence video to perform data analyses |
|
| Measure | Description | Time Frame |
|---|---|---|
| Maximum perfusion intensity (Normal) | 1. Maximum perfusion intensity (Imax, units) in a normal vascularized reference frame | Once during the surgery |
| Maximum perfusion intensity (ROI) | 2. Maximum perfusion intensity (Imax, units) in a normal vascularized reference frame | Once during the surgery |
| Relative Perfusion | Maximum perfusion intensity (Imax, units) in a normal vascularized reference frame / Maximum perfusion intensity (Imax, units) in a normal vascularized reference frame | Once during the surgery |
| Measure | Description | Time Frame |
|---|---|---|
| Tmax | Time to reach maximum perfusion in region of interest (Tmax, sec) | Once during the surgery |
| Ingress | Rate of increase in intensity from baseline to peak intensity (Ingress, units) |
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Inclusion Criteria:
Exclusion Criteria:
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We include patients that undergo a surgical debridement and/or reconstruction. Each group consists of twenty patients.
The debridement groups mainly consist of post-oncologic patients who have undergone radiotherapy (1A) and trauma patients (1B).
Reconstructive groups include 2A Fasciocutaneous flaps 2B Osseous flaps 2C Muscle flaps 2D Vaginaplasties 2E Phalloplasties 2F Finger replantations
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| Name | Affiliation | Role |
|---|---|---|
| Caroline Driessen | Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA) | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Amsterdam UMC | Amsterdam | Netherlands |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 40387116 | Derived | Van 't Hof LWP, Koster ITS, Van den Elzen RM, Bouman MB, Botman M, Driessen C. Quantitative Perfusion Assessment Using Indocyanine Green in Lower Extremity Perforator Flaps. Surg Innov. 2025 Oct;32(5):435-441. doi: 10.1177/15533506251339929. Epub 2025 May 19. |
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| ID | Term |
|---|---|
| D007208 | Indocyanine Green |
| ID | Term |
|---|---|
| D007211 | Indoles |
| D006574 | Heterocyclic Compounds, 2-Ring |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
| D006571 | Heterocyclic Compounds |
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| Phalloplasties |
Phalloplasties |
|
| Finger replantation | Finger replantation |
|
| Once during the surgery |
| Egress | Degree of decrease in intensity from peak to last measurement (Egress, units) | Once during the surgery |
| Lap Failure | Quantified as I <5%; II 5-15%, III 15-50%, IV> 50%, V complete | Follow up at six weeks postoperative |
| Wound infection | Defined as none, local wound treatment, antibiotics, or hospitalization. | Follow up at six weeks postoperative |
| Skin necrosis | Defined as none, partial thickness, and full thickness. | Follow up at six weeks postoperative |
| Delayed union | Radiologic examination (Xray or CT) concluding on the presence of delayed union after 6 months or non-union after 12 months | Follow up at six and twelve months postoperative |
| Relative Perfusion before and after tissue transfer | Maximum perfusion intensity (Imax, units) in the same reference frame after tissue transfer / Maximum perfusion intensity (Imax, units) in a reference frame before tissue transfer | Twice during the surgery |