Expanding role of indocyanine green (ICG) in head and neck cancer surgeries and reconstructive procedures: A preliminary observational study.

Abstract

e18070 Background: Indocyanine Green (ICG) fluorescence imaging is emerging as a valuable tool in assessing tissue perfusion during head and neck cancer surgeries, particularly in flap-based reconstructions. This study aims to evaluate the effectiveness of ICG imaging using NIR fluorescence imaging (Irillic NM) to determine the vascularity of various reconstructive flaps in head and neck cancer surgeries. Methods: This observational study involved 20 patients who underwent head and neck cancer surgeries with reconstructive procedures between January 2023 and August 2024. ICG was used to assess flap perfusion in free flaps (free radial forearm flap, free anterolateral thigh flap, and free fibula flap), pedicled flaps (PMMC flap), and random pattern flaps (Rotation flaps, nasolabial flap). A 1 ml dose of ICG dye was administered intravenously before evaluation with the NIR fluorescence imaging (Irillic NM), which employed colour fluorescence, overlay, white light, and SPY fluorescence modes to assess vascularity. Results: In 20 cases, ICG imaging provided critical insights into flap perfusion. In 3 cases, ICG revealed areas of inadequate perfusion in free flaps, prompting the immediate revision of the anastomosis, which resulted in improved flap survival. For pedicled and random pattern flaps, ICG identified areas of compromised vascularity, allowing for targeted excision of non-viable tissue. Specifically, in 5 cases of pedicled PMMC flaps and 2 instances of random pattern flaps (submental and nasolabial), ICG helped confirm adequate blood flow, contributing to successful reconstruction. Additionally, in 10 cases of cheek and neck flaps, ICG was essential in ensuring vascularity before proceeding with final closure. The NIR fluorescence imaging Irillic NM's multiple modes enabled precise differentiation between well-perfused and poorly perfused areas, ensuring optimal surgical outcomes. Conclusions: ICG fluorescence imaging, utilizing NIR fluorescence imaging (Irillic NM), offers an objective and reliable assessment of vascularity in reconstructive flaps during head and neck cancer surgeries. Its application has shown to be instrumental in improving surgical outcomes by allowing real-time adjustments based on perfusion data, particularly in complex reconstructive cases. Use of ICG imaging in assessing flap perfusion in head and neck reconstruction. Flap Type Total Cases (n=20) ICG Identified Issues Intervention Based on ICG Outcome Free Flaps 3 Inadequate perfusion Revision of anastomosis Improved flap survival Pedicled PMMC Flaps 5 Compromised vascularity Targeted excision of non-viable tissue Successful reconstruction Random Pattern Flaps 2 Compromised vascularity Targeted excision of non-viable tissue Successful reconstruction Cheek and Neck Flaps 10 No specific issues Ensured vascularity before closure Optimal surgical outcomes