Feasibility of Bone Perfusion Evaluation in Cadavers Using Indocyanine Green Fluorescence Angiography.

Journal: Plastic and reconstructive surgery. Global open
Published Date: Nov 20, 2017

Abstract

Bone perfusion evaluation methods in cadaver studies have yet to be established. The aim of this report was to introduce and validate the feasibility of indocyanine green (ICG) fluorescence angiography for evaluation of bone perfusion in the femoral medial condyle in cadavers. In 4 fresh nonembalmed cadavers (2 female), the descending genicular artery was dissected and carefully cannulated bilaterally. A 10 mL solution containing 5 mL ICG solution and 5 mL methylene blue solution was injected into the descending genicular artery. After the injection, the medial femoral condyle was cut with an oscillating saw. A photograph was taken of the cut ends of the bone. The cut ends of the bones were observed using a near-infrared camera. Images corresponding to the previously taken photographs of the cut ends were captured for comparative analysis. After injection of methylene blue and ICG, the blue dye could be seen in the periosteum in all specimens, but not inside the cortex or the cancellous region of the bone. When observed with ICG fluorescence angiography, however, the cancellous region was highlighted through small perforators penetrating the periosteum. Perfusion inside the medial femoral condyle in cadavers was confirmed using ICG fluorescence angiography. Our method can be especially beneficial in confirming the bone perfusion of a new bone flap based on a particular artery, both in cadavers as well as in patients, because ICG can be injected into specific arteries.

Authors

  • Hidehiko Yoshimatsu
    Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria; Department of Radiology, KFJ Hospital, Vienna, Austria; Department of Systematic Anatomy, Institute of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria; and Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
  • Johannes Steinbacher
    Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria; Department of Radiology, KFJ Hospital, Vienna, Austria; Department of Systematic Anatomy, Institute of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria; and Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
  • Stefan Meng
    Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria; Department of Radiology, KFJ Hospital, Vienna, Austria; Department of Systematic Anatomy, Institute of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria; and Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
  • Ulrike M Hamscha
    Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria; Department of Radiology, KFJ Hospital, Vienna, Austria; Department of Systematic Anatomy, Institute of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria; and Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
  • Wolfgang J Weninger
    Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria; Department of Radiology, KFJ Hospital, Vienna, Austria; Department of Systematic Anatomy, Institute of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria; and Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
  • Ines E Tinhofer
    Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria; Department of Radiology, KFJ Hospital, Vienna, Austria; Department of Systematic Anatomy, Institute of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria; and Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
  • Takumi Yamamoto
    Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria; Department of Radiology, KFJ Hospital, Vienna, Austria; Department of Systematic Anatomy, Institute of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria; and Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
  • Takuya Iida
    Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria; Department of Radiology, KFJ Hospital, Vienna, Austria; Department of Systematic Anatomy, Institute of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria; and Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
  • Chieh-Han John Tzou
    Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria; Department of Radiology, KFJ Hospital, Vienna, Austria; Department of Systematic Anatomy, Institute of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria; and Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.

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