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Head & Neck Oncology

Open Access

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

  • Sven Zhorzel1,
  • Herbert Stepp2,
  • Miriam Havel1,
  • Waseem Jerjes3,
  • Tahwinder Upile3,
  • Colin Hopper3,
  • Ulrich Harréus1 and
  • Christian S Betz1
Head & Neck Oncology20091(Suppl 1):P29

Published: 28 July 2009


Reconstructive SurgeryNeck SurgeryRevision SurgerySurrounding TissueCurrent 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, Munich, Germany
Laser-Research Laboratory, LIFE Center, Ludwig Maximilian University, Munich, Germany
Department of Oral and Maxillofacial Surgery, University College London Hospital, London, UK


© Zhorzel et al; licensee BioMed Central Ltd. 2009

This article is published under license to BioMed Central Ltd.