IC-Flow™ Indications | Plastic Surgery


Evaluation of flap perfusion

ICFlow-PlasticSurgery-2
ICFlow-PlasticSurgery-2a
Chest reconstruction, Dr. Ulf Dornseifer, Klinikum Bogenhausen, München, Germany.

In plastic and reconstructive surgery, the IC-Flow™ Imaging System is used to visualize the perfusion of the skin and muscle flaps in real-time, and support the clinical decision making. The real-time assessment of dynamic flap perfusion can be used to select the optimal perforator and to design the flap.For example, the perfusion of a SIEA flap could be observed. If the perfusion is not sufficient, then the surgeon can switch to a DIEP flap. In addition, following the placement of the flap, the patency of the arterial and venous anastomoses can be checked intraoperatively. Furthermore, the perfusion of the flap can be assessed after transplantation in order to eliminate possible complications.

ICFlow-PlasticSurgery-BreastReconstruction
Breast reconstruction, Professor Masia. Clinica Planas, Barecelona, Spain


Visualization of the subcutaneous lymph system

In plastic surgery the IC-Flow™ Imaging System can also be used for lymph angiography to visualize the superficial lymphatics in real-time. The actual anatomy and location of the lymph vessels can be observed. The transportation of lymph can be observed and the flow velocity can be measured.

The most common application of lymph angiography is for the diagnosis and treatment of secondary lymphedema. Secondary lymphedema is one of the most common diseases of the lymphatic system. If left untreated, lymphedema will usually worsen, resulting in strong pain and swelling as well as an increase in the size and weight of the affected limb. Therefore, an early and correct diagnosis along with an appropriate treatment plan are important.2

Procedure:

fig_1_small
ICFlowFluorescenceLymphangiography
1. Injection
Fluorescent dye is injected intradermally at the hand or foot of the affected limb.
2. Fluorescence Lymphangiography
The IC-Flow is used to detect the fluorescent dye which is transported by the lymphatic vessels.The fluorescence visualization of the lymphatic system can be observed within a few minutes. The speed and pattern of the fluorescence imaging depends on individual physiology and the severity of the lymphedema.Fluorescence pathways can be mapped to facilitate planning and delivery of the treatment.

ICFlow-LinearConnections
Linear Collectors
ICFlow-ReroutingLymph
Rerouting Lymph

 


Performance of Lymphatico-Venous Anastomoses (LVA)

ICFlow-LVA
LVA procedure, Professor Masia Jaume, Barcelona (2014)
In cases of secondary lymphedema where there are still lymph vessels with good flow, lymphatico-venous anastomoses are a possible treatment option.
Procedure:

  1. Injection: Intradermal injection of fluorescent dye in the affected limb
  2. Observation: The IC-Flow Imaging System is used to detect the lymph vessels which will be marked before the incisions. During the surgery the identified lymph vessels are observed in order to choose the most suitable one for anastomosis.
  3. Lymphatico-venous anastomosis (LVA): An anastomsis between the identified vein with an appropriate size and the lymphatic vessel is performed using a fluorescence imaging microscope. If possible, multiple LVA’s are executed.
  4. Control of LVA: The patency of lymphatic-venous anastomosis is confirmed by visualizing the lymphatic flow with IC-Flow during the surgery. LVA’s should lead to improved lymphatic drainage and therefore a reduction of the edema.

 


References

    Corinne Becker, Julie V. Vasile, Joshua L. Levine, Bernardo N. Microlymphatic Surgery for the Treatment of Iatrogenic Lymphedema. Clin Plastic Surg 39 (2012) 385–398.

  1. Mihara M, Hara H, Araki J, Kikuchi K, Narushima M, Yamamoto T, Iida T, Yoshimatsu H, Murai N, Mitsui K, Okitsu T, Koshima I. Indocyanine Green (ICG) Lymphography Is Superior to Lymphoscintigraphy for Diagnostic Imaging of Early Lymphedema of the Upper Limbs. PLoS One 2012; 7(6): e38182.
  2. Mihara M, Hara H, Hayashi Y, Iida T, Araki J, Yamamoto T, Todokoro T, Narushima M, Murai N, Koshima I Upper‐Limb Lymphedema Treated Aesthetically with Lymphaticovenous Anastomosis using Indocyanine Green Lymphography and Noncontact Vein Visualization. J Reconstr Microsurg 2012; 28(5): 327‐32
  3. Mukenge SM, Catena M, Negrini D, Ratti F, Moriondo A, Briganti A, Rigatti P, Cipriani F, Ferla G Assessment and Follow‐Up of Patency After Lymphovenous Microsurgery for Treatment of Secondary Lymphedema in External Male Genital Organs. Eur Urol. 2011; 60(5): 1114‐9
  4. Yamamoto T, Narushima M, Doi K, Oshima A, Ogata F, Mihara M, Koshima I, Mundinger GS Characteristic indocyanine green lymphography findings in lower extremity lymphedema: the generation of a novel lymphedema severity staging system using dermal backflow patterns. Plast Reconstr Surg 2011; 127(5): 1979‐86
  5. Takumi Yamamoto, Nana Yamamoto, Takao Numahata, Ai Yokoyama, Kensuke Tashiro, Hidehiko Yoshimatsu, Mitsunaga. „Navigation Lymphatic Supermicrosurgery for the Treatment of Cancer-Related Peripheral Lymphedema”. Vasc Endovascular Surg 2013; epub.
  6. Unno, N., M. Nishiyama, et al. (2008). Quantitative lymph imaging for assessment of lymph function using indocyanine green fluorescence lymphography. Eur J Vasc Endovasc Surg 36(2): 230-6.

 


Flap Perfusion

Source: Flap perfusion for breast reconstruction, Hamamatsu, Japan

Lymphangiography

Source: Belgrado JP.,Vandermeeren L., Université libre de Bruxelles, Brussels