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  • Poster presentation
  • Open Access

Endoscopic examinations of free flap perfusion in the head and neck region using red-excited Indocyanine Green

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Head & Neck Oncology20091 (Suppl 1) :P29

  • Published:


  • Reconstructive Surgery
  • Neck Surgery
  • Revision Surgery
  • Surrounding Tissue
  • Current Investigation


Malfunction of microvascular anastomoses is regarded as the main reason for failure of free tissue transfer. It was the aim of the current investigation to prove the feasibility and to explore the clinical benefit of endoscopically guided free flap perfusion measurements in the head and neck region using red-excited Indocyanine Green (ICG).


25 patients who underwent reconstructive surgery including free tissue transfer to the head and neck region took part in this study. Each participant underwent 3 ICG-angiographies (intraoperatively, 24 hrs and 72 hrs postoperatively). The obtained data were evaluated online and offline on PC, and the results compared to the clinical outcome.


There were no partial or complete losses of transplants. Two flaps with an early arterial failure were successfully salvaged by revision surgery. The ICG-angiographies were tolerated well. The gain of fluorescence was delayed in the transplanted tissue when compared to the surrounding tissue, whereas the final maximum fluorescence intensities were comparable. The two flaps with the initial compromise in perfusion showed relative fluorescence maxima (transplant vs. surrounding) of 33% or 37%, respectively, whereas these values lay above 64% for all other examinations.


It was possible to prove the feasibility of endoscopic ICG angiographies in patients with free tissue transfer to the upper aerodigestive tract. The method is easy to perform and there were no adverse events. Especially in difficult situations (e.g. questionable Doppler signals, flaps situated far down in the pharynx...) the method seems to be a welcome adjunct to conventional screening.

Authors’ Affiliations

Department of Otorhinolaryngology, Head & Neck Surgery, Ludwig Maximilian University Munich, Marchioninistr, Munich, Germany
Laser-Research Laboratory, LIFE Center, Ludwig Maximilian University, Marchioninistr. 23, 81377 Munich, Germany
Department of Oral and Maxillofacial Surgery, University College London Hospital, Mortimer Market, London, WC1E 6AU, UK


© Zhorzel et al; licensee BioMed Central Ltd. 2009

This article is published under license to BioMed Central Ltd.