Uses of laser-assisted angiography in head and neck reconstruction

Introduction Laser-assisted indocyanine green angiography (LAIGA) has been shown to be a useful real-time measure of tissue perfusion. This project aims to describe LAIGA uses with local and free flaps in head and neck reconstructive surgery both at our institution and in the literature. Methods This retrospective study included 15 patients undergoing regional or free flap head and neck reconstruction where the surgeon utilized LAIGA at a single tertiary medical center from July of 2021 to January of 2022. We analyzed intraoperative use of LAIGA as a measure of tissue perfusion for varying indications with the main outcome being descriptions of these various uses and documenting complications related to poor flap perfusion. Results Of the 15 patients included, 9 were male and 6 female, 14 had squamous cell carcinoma and 1 had a gunshot wound as their primary defect. We analyzed LAIGA use with 18 flaps as two patients had two separate operations, and one patient had two free flaps within one operation. There were 5 anterolateral thigh (ALT) flaps, 4 fibular free flaps, 3 supraclavicular artery island flaps, 3 forearm free flaps, one anterolateral thigh osteomyocutaneous flap and one scapular free flap. LAIGA was most frequently used to assess viability of the flap after it was lifted from underlying tissues prior to inset[WT1] [MZ2] , it was also used to locate perforators to optimize ALT flap design, assess distal flap perfusion intraoperatively, and assess flap perfusion postoperatively. Conclusion LAIGA proves to be broadly useful in head and neck reconstructive surgery. This case series demonstrates the diversity of indications and uses that LAIGA can have to help optimize reconstructive outcomes