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Assessment Of Perfusion In A Partial Face Transplanation Model With A Near-Infrared Imaging System.
J. T. Nguyen, MD, Y. Ashitate, MD, A. Ibrahim, MD, S. Gioux, MD, P. P. Patel, MD, J. V. Frangioni, MD, B. T. Lee, MD
Beth Israel Deaconess Medical Center - Harvard Medical School, Boston, MA
Background: Composite tissue allografts (CTAs) have many applications in microsurgery including more recently the possibility of partial face composite tissue allotransplantation. There is however, significant risk of tissue ischemia and rejection. Near Infrared (NIR) fluorescence imaging systems can provide a composite intra-operative evaluation of perfusion in real time.This study analyzed the ability of (NIR) fluorescence imaging to effectively monitor and assess perfusion and viability of harvested partial face CTAs.
Methods: Hemi-facial CTAs were created (N=6) using a model for hemifacial transplantation (Figure 1A). It was then assessed intra-operatively by clinical examination and confirmed with doppler ultrasound. Intraoperative perfusion was also assessed with NIR fluorescence imaging. Animals were injected with indocyanine green (ICG) and NIR fluorescence excitation (745-779 nm). NIR fluorescence images were obtained simultaneously with color video and merged images were formed.
Results: With NIR imaging, arterial perforators emitted fluorescence indicating perfusion along the surface of the skin paddle (Figure 1B). Pedical perfusion was discerned through an arterial and venous phase (Figure 1C and 1D respectively). Quantitative metrics for arterial and venous perfusion were assessed.
Conclusion: The ability to evaluate and assess perfusion and viability of CTAs is highly valuable in facial transplantation. NIR fluorescence imaging shows promise as technology with the ability to assess tissue perfusion during elevation and harvest of a composite flap and to monitor perfusion after microsurgical anastamosis. Ultimately, this technology can decrease the failure rate of CTAs.
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