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J Reconstr Microsurg 2019; 35(02): 108-116
DOI: 10.1055/s-0038-1667364
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Effect of Segment Length and Number of Osteotomy Sites on Cancellous Bone Perfusion in Free Fibula Flaps

Andreas M. Fichter
1   Department of Oral and Cranio-Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
,
Lucas M. Ritschl
1   Department of Oral and Cranio-Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
,
Rali Georg
1   Department of Oral and Cranio-Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
,
Andreas Kolk
1   Department of Oral and Cranio-Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
,
Marco R. Kesting
2   Department of Oral and Maxillofacial Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
,
Klaus-Dietrich Wolff
1   Department of Oral and Cranio-Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
,
Thomas Mücke
1   Department of Oral and Cranio-Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
3   Department of Oral and Maxillofacial Surgery, Malteser Kliniken Rhein-Ruhr, Krefeld-Uerdingen, Germany
› Author Affiliations Funding No external funding source had any influence on the study design; in the collection, analysis, or interpretation of data; in the writing of the report; or in the decision to submit the article for publication.
Further Information

Publication History

06 April 2018

14 June 2018

Publication Date:
12 August 2018 (online)

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Abstract

Background Indocyanine green (ICG) videoangiography is routinely used to evaluate skin and organ perfusion and to assess patency rates of microvascular anastomoses. This study uses ICG angiography as a novel approach to qualitatively and quantitatively evaluate bone perfusion of microvascular fibula grafts intraoperatively and to assess the effect of fibula segment length and number of osteotomies on bone perfusion.

Methods All patients planned for mandible reconstruction using a microvascular fibula graft between January 2013 and May 2017 were considered for this study. ICG videoangiography of cancellous bone perfusion was performed using a handheld ICG camera. Videos were analyzed, and a perfusion curve was generated. Peak enhancement, time to peak, slope, and wash-in area under the curve were extracted; rise time, wash-in rate (WiR), and wash-in perfusion index were calculated. Results were statistically analyzed with regard to distal fibula segment length and number of osteotomy sites.

Results Thirty-nine patients (age 59 ± 8 years) were included in the study. Mandible reconstruction was achieved with 1 (n = 15), 2 (n = 13), or 3 (n = 11) fibula segments. The WiR was 6.4 ± 2.3 and 4.4 ± 0.2 before and after proximal osteotomy, respectively. The wash-in perfusion index was 114.2 ± 48.4 before and 84.4 ± 20.0 after proximal osteotomy. Bone perfusion was significantly reduced after additional proximal osteotomies. Both the segment length and number of proximal osteotomies correlated with bone perfusion, with longer segments and fewer osteotomies showing higher perfusion.

Conclusion This study demonstrates the feasibility of cancellous bone perfusion analysis using ICG and can serve as a basis for future bone perfusion studies. Additional osteotomies and short segment length negatively affects cancellous bone perfusion of the distal fibula segment in free fibula flaps. The extent to which the observed decrease in arterial inflow to the distal fibula segment affects the further course of healing needs to be addressed in future studies.

Keywords

flap - surgery - fluorescence - imaging - bone perfusion

Supplementary Material

 

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