Does the Use of Intraoperative Angiography Reduce the Incidence of Postoperative Wound and Flap Complications in Complex Lower Extremity Oncologic Reconstruction?
Margaret Dalena, BS, Kailash Kapadia, MD, Joseph Weisberger, MD, James Potter, BS, Haripriya Ayyala, MD, Zachary Cavanaugh, MD, Joseph Benevenia, MD, Edward Lee, MD.
Rutgers New Jersey Medical School, Newark, NJ, USA.
Introduction: Intraoperative laser angiography via indocyanine green (ICG) has become a valuable tool in assessing tissue perfusion in reconstructive procedures. Given the increased expenses associated with postoperative complications, prevention of these outcomes while maintaining cost efficiency is of the utmost importance. Current literature reports the cost of ICG per use ranges from $795 to $1295. The objective of this study is to compare wound and flap complications in lower extremity oncologic reconstruction treated with or without laser assisted ICG angiography.
Methods: Sixty-one patients undergoing complex orthopaedic oncologic resection and plastic surgery soft tissue reconstruction treated at a single institution from 2010-2018 were retrospectively reviewed. From these patients, a total of seventy-six reconstructive procedures were analyzed. Patients with plastic surgery reconstruction utilizing ICG angiography (n=36) were compared to those without angiography (n=40). Demographics, comorbidities, operative procedures, gross defect size, and postoperative complications were analyzed.
Results: There was no significant difference in age, gender, smoking status, history of chemotherapy or radiation, or comorbidities between the two cohorts. Mean defect size was similar between ICG and non-ICG groups. There was no statistically significant difference in the rates of postoperative wound complications or flap complications. Postoperative wound complications occurred in 19.4% of ICG patients (7/36) and in 20% of Non-ICG patients (8/40). Postoperative flap complications occurred in 11.1% of ICG patients (4/36) and in 10% of Non-ICG patients (4/40). There was no statistically significant difference in the re-operation rate due to a wound or flap complication between the ICG and Non-ICG groups (0.53 vs 0.63).
Conclusion: The incidence of postoperative wound complications after complex orthopaedic oncologic resection and plastic surgery reconstruction remains high. The utilization of intraoperative ICG angiography did not lead to a decrease in wound complications, flap complications, or required returns to the OR in our study. Clinical judgement of flap and soft tissue viability may lead to comparable operative outcomes with potential benefit for cost savings. Long-term follow-up and prospective studies are needed to further investigate this trend.
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