The aim of this study was to prove the hypothesis that intraoperative fluorescence-angiography using indocyanine-green (ICGFA) can be used to predict the occurrence of perfusion-associated complications following microvascular reconstruction. Data of 67 patients (male/female: 41/26) with an average age of 64 years (range 29–84 years) were analyzed. In 10 of these patients, postoperative perfusion-associated complications were observed (arterial/venous/microcirculatory: 4/3/3; p = 0.12). The analysis of the intraoperatively obtained flow parameters showed a significant difference in the ratio of maximum and minimum intensity in arterial pedicle perfusion (Fmax/min) of patients with and without complications (with vs. without complications: 2.3 ± 1.0 vs. 5.0 ± 4.9; p < 0.01) and strong correlation of the mentioned parameter with the occurrence of perfusion-associated complications (odds ratio = 0.27; p = 0.01).

Potentially, intraoperative near-infrared ICG-based fluorescence-angiography in the pedicle vessels of a free flap may identify parameters of blood flow that can be used to predict perfusion-associated flap failure, which could influence the intraoperative decision to redo the anastomosis. The present study shows the value of ICG fluorescence-angiography as a routine clinical tool to predict flap failure after microvascular reconstruction in the head and neck region. The data indicate that ICGFA may, in the future, provide an objective method to decide intraoperatively whether or not to immediately revise an anastomosis to prevent flap loss or salvage surgery.

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