Enhancing Safety in Head and Neck Cancer Surgery Through Free-Flap Reconstruction Using Indocyanine Green Angiography

循血綠血管顯影劑應用於頭頸癌以降低頭頸癌游離皮瓣重建之併發症和失敗率

Kuan-Chen Li(李冠臻)；Yu-Hsien Lin(林育賢)；Hwang-Chi Lin(林煌基)；Cha-Chun Chen(陳柵君)；Chu-Hsu Jeng(鄭舉緒)；Shang-Hsi Lin(林上熙)

indocyanine green ； free-flap reconstruction ； head and neck cancer

臺灣整形外科醫學會雜誌

33卷2期（2024 / 06 / 01）

147 - 160

英文;繁體中文

Background: Free-flap failure during head and neck reconstruction can be a devastating outcome for both patients and surgeons. Various intraoperative examinations and techniques are employed to evaluate the patency of the anastomosed vessel as well as the perfusion of the free-flap. However, most of these methods are subjective and sometimes causing dilemma for unexperienced surgeon. By utilizing fluorescent indocyanine green angiography intraoperatively, surgeons can have an objective method to assess the perfusion of the free-flap and patency of the anastomosed vessel. Aim and objective: To determine whether intraoperative fluorescent indocyanine green angiography can reduce the postoperative free-flap complication rate and risk of flap loss. Materials and methods: A total of 121 patients with head and neck cancer underwent wide excision and free-flap reconstruction performed by a single surgeon between January 2020 and March 2021. Of these patients, 61 underwent both intraoperative Doppler and indocyanine green confirmation, whereas the remaining 60 underwent only intraoperative Doppler assessment. We analyzed the demographics of the patients in both groups and assessed the postoperative complication rates. Results: The application of intraoperative indocyanine green angiography was associated with significantly lower rates of minor complications (p = 0.016) and an overall lower complication rate (p = 0.006). In addition, there was a noticeable trend suggesting a lower rate of major complications in the group that received intraoperative indocyanine green angiography. Conclusion: Indocyanine green angiography can enable the surgeon to objectively assess vascular patency and free-flap perfusion during surgery. Consequently, the postoperative complications rate is lowered.

背景：頭頸癌游離皮瓣重建手術的失敗對於病人和醫師來說都是一個棘手的問題。現今有許多的方法被應用於評估血管吻合的暢通性和游離皮瓣的血液灌流狀況。然而大多數的評估方法是主觀的而且對於經驗少的醫生來說判斷比較不可靠。本文介紹藉著使用循血綠螢光血管顯影劑於游離皮瓣手術中，提供一個客觀的方式評估皮瓣的血循和血管的吻合狀況。目的及目標：本文目的探討使用術中循血綠螢光血管顯影劑於游離皮瓣手術，是否能夠有效降低皮瓣的併發症跟失敗率。材料及方法：本文統計了121位頭頸癌接受大範圍腫瘤切除及游離皮瓣重建之病人。統計時間為2020年1月至2021年3月，游離皮瓣重建手術均由同一位醫師執行。121位裡面有61位接受術中循血綠螢光顯血管顯影劑和杜普勒監測，另外60位只接受術中杜普勒監測。我們統計並分析兩組病人的族群分布和游離皮瓣術後的併發症跟失敗率。結果：術中使用循血綠螢光血管顯影劑可以有效的降低游離皮瓣術後的次要併發症，有統計上的顯著差異（p= 0.016），也可有效的降低術後總併發症（p = 0.006）。除此之外，也觀察到使用術中循血綠螢光血管顯影劑有明顯的趨勢顯示可降低重大的術後併發症。結論：於術中使用循血綠螢光血管顯影劑可讓外科醫生客觀的評估血管吻合的暢通性和游離皮瓣的血液灌流狀態。並降低術後的併發症。