ASSESSMENT OF MICROCIRCULATION OF AN AXIAL SKIN FLAP USING INDOCYANINE GREEN FLUORESCENCE ANGIOGRAPHY

In many cases the complexities of skin-flap microcirculation are diffi cult to assess despite all the subjective and objective examination te chniques available today. Adequate microcirculation is essential for t issue viability, so any method employed for studying microcirculation should provide as accurate an assessment of the prevailing conditions as possible. Of all the clinical methods, the fluorescence technique u sing the dye sodium fluorescein has so far provided the most reliable results. However, the pharmacokinetic properties of this tracer have p revented the technique from becoming established in clinical practice. The fluorescent dye indocyanine green (Cardio Green), on the other ha nd, has far more favorable pharmacokinetics. In an experimental animal model, the fluorescence technique using indocyanine green (indocyanin e green angiography, ICGA) was used to study postoperative changes in the microcirculation of a skin flap. On the day of operation, indocyan ine green angiography revealed a state of hemodynamic imbalance for wh ich the organism was able to compensate in the postoperative phase wit h the aid of humoral, physical, and metabolic factors. With indocyanin e green angiography it was possible to quantify objectively the new he modynamic equilibrium. Basically, microcirculation may be quantified i n temporal and spatial terms. The significant objectivity of indocyani ne green angiography and short intervals between each examination favo r its possible and meaningful use in clinical practice and give cause for continuing studies.