Sebald ATE, Ludolph I, Mundschau C, Arkudas A, Horch RE (2026)
Publication Type: Journal article
Publication year: 2026
Book Volume: 51
Pages Range: 584-593
DOI: 10.1016/j.jpra.2026.07.016
Background: Pedicled perforator propeller flaps are widely used for soft-tissue reconstruction because they preserve donor-site function while providing reliable defect coverage. However, intraoperative assessment of flap perfusion remains challenging, particularly in longer flaps or after axial rotation. Indocyanine green (ICG) fluorescence angiography allows real-time visualization of tissue perfusion and may improve intraoperative decision-making. Methods: A retrospective single-center study was performed including 30 patients who underwent reconstruction with pedicled perforator propeller flaps between 2014 and 2022. Intraoperative ICG angiography was performed using the SPY-Elite system after flap elevation and after inset. A total of 48 angiographic sequences were analyzed using ImageJ software. Fluorescence intensity, perfusion distribution, and contour levels (20% and 30%) were evaluated across standardized 3-cm flap segments from the perforator origin to the distal flap edge. Results: All flaps survived, resulting in a flap survival rate of 100%. Postoperative complications occurred in 6 patients (20%), including 3 cases of minor wound-healing disorders and 3 cases of venous congestion requiring revision. Mean flap length was 15.8 cm. The average perfused area at the 20% fluorescence contour level represented 97.2% of the total flap surface. Perfusion decreased progressively with increasing distance from the perforator and declined significantly in flaps exceeding 15 cm in length (p < 0.01). Flaps shorter than 10 cm demonstrated homogeneous perfusion across all segments. Lower extremity flaps showed more consistent perfusion patterns compared with truncal and gluteal flaps. Conclusions: Intraoperative ICG fluorescence angiography provides a reliable method for assessing perfusion in pedicled perforator propeller flaps. Perfusion mapping suggests that flap lengths under 10 cm and tissue areas within the 20%–30% fluorescence contour levels are associated with consistent viability. ICG angiography may therefore serve as a useful adjunct to optimize flap design and enhance surgical safety in reconstructive procedures.
APA:
Sebald, A.T.E., Ludolph, I., Mundschau, C., Arkudas, A., & Horch, R.E. (2026). Exploring perfusion limits in pedicled perforator propeller flaps via intraoperative indocyanine green angiography. JPRAS Open, 51, 584-593. https://doi.org/10.1016/j.jpra.2026.07.016
MLA:
Sebald, Adrian Thomas Erwin, et al. "Exploring perfusion limits in pedicled perforator propeller flaps via intraoperative indocyanine green angiography." JPRAS Open 51 (2026): 584-593.
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