Prediction of flap necrosis with laser induced indocyanine green fluorescence in a rat model

R. E. Giunta, T. Holzbach, C. Taskov, P. S. Holm, T. Brill, R. Busch, B. Gansbacher, E. Biemer

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92 Scopus citations


Prediction of necrosis has a clinical relevance in all fields of plastic surgery. The new application of indocyanine green (ICG) fluoroscopy in plastic surgery allows an objective quantification of skin perfusion and a high topographical resolution. The aim of the present study is to determine threshold values for flap perfusion under well-defined experimental conditions. Twenty random pattern flaps with a length to width ratio of 4:1 (8×2 cm2) were dissected on the anterior abdominal wall of 20 male Sprague-Dawley rats. ICG fluoroscopy was performed at the end of the operation. The animals were sacrificed at the seventh postoperative day with a reliable necrosis of the distal part of the flaps. Postoperative ICG fluoroscopy then was analysed both in regions that will survive and undergo necrosis. At day 7 a mean area of 5.5 cm2 (57% of the total flap area) survived and a mean of 3.8 cm2 (43%) became necrotic. The surviving part of the flap had a mean perfusion index of 62% compared to reference skin. The distal parts of the flap that necrotised showed an average perfusion index of only 19% postoperatively. Differences were statistically highly significant (p<0.001). Indocyanine green fluoroscopy is a useful tool to evaluate perfusion topographically and predict necrosis. From a statistical point of view a perfusion index of less than 25% of the reference skin can be considered as a sign of developing flap necrosis.

Original languageEnglish
Pages (from-to)695-701
Number of pages7
JournalBritish Journal of Plastic Surgery
Issue number5
StatePublished - Jul 2005


  • Flap monitoring
  • Flap necrosis
  • Indocyanine green fluoroscopy
  • Random pattern flap


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