Fluorescence Angiography With Fluobeam™ Camera (Fluoptics Company): Planning and Monitoring of Perforator Flaps
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Reconstructive Surgery
- Sponsor
- University Hospital, Grenoble
- Enrollment
- 27
- Locations
- 1
- Primary Endpoint
- Comparison between the position of perforator flap determined by fluorescence angiography and the real anatomic position of the flap determined after dissection
- Status
- Terminated
- Last Updated
- 7 years ago
Overview
Brief Summary
The purpose of this study is to determine whether fluorescence angiography is an effectiveness technique for the localization of vascular perforators and their area of perfusion and for the postoperative monitoring of flap perfusion.
Detailed Description
Reconstructive surgery is intended to replace amputated anatomical regions by autologous tissue taken from distant locations: flaps. The goal is to restitute ad integrum with minimal sequelae. Among the flaps available, perforator flaps have the advantage of being highly plastic, large and can be taken from accessory vessels the loss of wich does not compromise the vitality of the sampling site. However their more variable anatomy requires irradiating preoperative morphological assessment (CT angiography) or a doppler ultrasonography that is not always performed by the surgeon himself and does not distinguish between muscle perforator and skin perforator. Fluorescence angiography is a superficial exploration technique of vascularization. After intravenous injection of a tracer (indocyanine green ICG), fluorescence angiography provides useful surface angiographic imaging in real-time. It can also help in monitoring intraoperative and postoperative quality of vascular anastomoses. Although fluorescence angiography has numerous applications (ophthalmology, neurosurgery, liver transplantation...), its usefulness in surgical flaps is only supported by a few publications. None really validate its clinical value by comparing it to reference investigations (CT angiography or doppler ultrasonography). 40 candidate for reconstructive surgery will be included in this study. The day before surgery, in addition to the usual technique used to locate perforator flaps, the patient will receive an injection of 0.025 mg / kg Infracyanine® (indocyanine green) and the area of interest of the flap will be explored with the Fluobeam™ camera. Two hours after the surgery, during the usual clinical monitoring of the vitality of the flap, a new injection of Infracyanine® will test perfusion of the flap by measuring fluorescence intensity of the target area. These measurement will then be repeated every 6 hours for 4 days.
Investigators
Eligibility Criteria
Inclusion Criteria
- •perforator flap reconstruction whatever the indication (cancer, trauma, malformations). The main targets are the fibula flaps, anterolateral thigh flaps and inferior epigastric flaps
- •consenting patient
Exclusion Criteria
- •known indocyanine green allergy
- •pregnant woman, parturient woman or nursing woman
Outcomes
Primary Outcomes
Comparison between the position of perforator flap determined by fluorescence angiography and the real anatomic position of the flap determined after dissection
Time Frame: During the first fluorescent angiography
For each flap, the position of the flap determined by fluorescent angiography will be compared with the anatomic position (actual) determined on the relevant flap after dissection (gold standard).
Secondary Outcomes
- Comparison between the position of the perforator flap determined by fluorescence angiography and the position of the flap determined by reference imaging techniques relevant to the flap (CT angiography or doppler ultrasonography)(During the first fluorescent angiography)
- Postoperative monitoring of flap perfusion using fluorescence angiography(Every six hours for four days after surgery)
- Intraoperative monitoring of the quality of micro-vascular anastomoses using fluorescent angiography(Just after micro-vascular anastomoses)