Original Article: PDF OnlyUse of Indocyanine Green Angiography to Identify the Superficial Temporal Artery and Vein in Forehead Flaps for Facial ReconstructionZang, Mengqing MD; Zhu, Shan MD; Chen, Bo MD; Li, Shanshan MD; Han, Tinglu MD; Liu, Yuanbo MD Author Information Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China. Address correspondence and reprint requests to Yuanbo Liu, MD, Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 33 Ba-Da-Chu Road, Shijingshan District, Beijing 100144, China; E-mail: [email protected] Received 11 February, 2021 Accepted 14 November, 2021 Mengqing Zang is currently receiving a grant (No. 3332019061) from Fundamental Research Funds for the Central Universities. Level of Evidence: Level IV, Series case study. Ethical approval: All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Conflicts of Interest and Source of Funding: Dr. Mengqing Zang is currently receiving a grant (No. 3332019061) from Fundamental Research Funds for the Central Universities. For the remaining authors, none were declared. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jcraniofacialsurgery.com). Journal of Craniofacial Surgery: December 01, 2021 - Volume - Issue - doi: 10.1097/SCS.0000000000008397 Buy SDC PAP Metrics Abstract The superficial temporal artery (STA) frontal branch flap is susceptible to venous congestion because of its unpredictable and variable outflow. The authors applied indocyanine green angiography in identifying the superficial temporal vessels to help surgeons with proper flap designs to avoid severe complications. A retrospective review from 2015 to 2020 was conducted. All the patients who underwent indocyanine green angiography before forehead flap transfer for facial defect reconstruction were reviewed. The STA and vein were observed using indocyanine green angiography preoperatively. The relationship between the artery and vein was investigated. The venous anatomy was analyzed to guide the pedicle design. The survival of the flap and complications were assessed. A total of 12 patients were identified and included in this study. Indocyanine green angiography allows clear visualization of the detailed anatomy of the STA and vein. The frontal branch of the vein had great variations and generally diverged from the arterial branch. The tiny venae comitantes provided sufficient drainage for 2 small forehead flaps. The frontal branch of the vein entered the forehead and was used as the outflow channel in 4 patients. The parietal branch of the vein, which consistently gave off secondary tributaries to the superior forehead, was included in the pedicle in 6 patients. All flaps survived without complications. Indocyanine green angiography provided accurate localization of the superficial temporal vessels. This technique may be helpful in the precise planning forehead flap surgeries and in avoiding the risk of venous congestion. © 2022 by Mutaz B. Habal, MD.