Clinical assessment of flap perfusion by fiberoptic fluorometry.

Perfusion fluorometry, a method which quantifies tissue fluorescence after intravenous fluorescein injection, has been highly predictive of skin flap survival in animals. It is advantageous because it is objective, simple, noninvasive, repeatable, and can be used to monitor flap perfusion constantly by following both uptake and elimination of dye. We applied this method clinically to a variety of flaps used in head and neck surgery. All flaps with good fluorometric values survived totally. Based on experience with 37 flaps, fluorometric indices have been established that accurately predict necrosis. Serial dye injections have been used to document transient flap ischemia in the early postoperative period. Representative cases illustrating the advantages of fluorometry in flap assessment are presented.

Serial fluorometric assessment of experimental neurovascular island flaps.

Quantification of tissue sodium fluorescein delivery was used to monitor neurovascular island flaps subjected to various manipulations of the vascular pedicle. In 20 anesthetized rats, inferior epigastric neurovascular island flaps were studied during transient arterial or venous occlusion and presumed vascular spasm. During clamping, there was no substantial fluorescein uptake by the flaps. Reinjection of fluorescein after removal of the clamps resulted in adequate fluorescein uptake and elimination in those flaps that remained viable. Three of the flaps with presumed vascular spasm eventually evidenced an increase in fluorescence with subsequent injections and remained viable; one flap did not show adequate fluorescence after any of the four injections and subsequently necrosed. It is concluded that documentation of tissue fluorescein delivery following serial injections of dye permits accurate monitoring of the functional status of the vascular pedicle at close-time intervals during the critical hours immediately after flap construction.