Institutional members access full text with Ovid®

Share this article on:

Early Experience with Fluorescent Angiography in Free-Tissue Transfer Reconstruction

Pestana, Ivo A. M.D.; Coan, Brian M.D.; Erdmann, Detlev M.D., Ph.D.; Marcus, Jeffrey M.D.; Levin, L Scott M.D.; Zenn, Michael R. M.D.

Plastic and Reconstructive Surgery: April 2009 - Volume 123 - Issue 4 - p 1239-1244
doi: 10.1097/PRS.0b013e31819e67c1
Reconstructive: Lower Extremity: Original Articles

Background: Soft-tissue and bony reconstruction with free-tissue transfer is one of the most versatile tools available to the reconstructive surgeon. Determination of flap perfusion and early detection of vascular compromise with prompt correction remain critical in free-tissue transfer success. The aim of this report is to describe the utility of laser-assisted indocyanine green fluorescent dye angiography in free-tissue transfer reconstruction.

Methods: From October of 2007 to March of 2008, 27 nonrandomized, nonconsecutive patients underwent surgical free flaps in conjunction with intraoperative Novadaq SPY fluorescent angiography.

Results: Twenty-seven patients underwent 29 free-tissue transfers. There was one partial flap loss in this group requiring operative revision. No complications attributable to indocyanine green fluorescent dye administration were noted. Imaging procedures (including dye administration) added minimal additional time to the operative time and anesthesia, and assisted in intraoperative decision-making.

Conclusions: Novadaq’s SPY fluorescent angiography system provides simple and efficient intraoperative real-time surface angiographic imaging. This technology places control of vascular anastomosis evaluation and flap perfusion in the hands of the surgeon intraoperatively in a visual manner that is easy to use and is helpful in surgical decision-making.


Durham, N.C.

From Duke University Medical Center.

Received for publication September 1, 2008; accepted November 7, 2008.

Disclosure: Novadaq supplied the SPY fluorescent angiography system at no charge to Duke University Medical Center for the study. No other financial support was obtained. Since the acceptance of this article, Dr. Zenn has become a paid consultant for Novadaq Corporation. This change of disclosure does not affect this publication and has been so noted in the Plastic and Reconstructive Surgery and American Society of Plastic Surgeons disclosures submitted since.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text; simply type the URL address into any web browser to access this content. Clickable links to the material are provided in the HTML text of this article on the Journal’s Web site (

Michael Robert Zenn, M.D.; Baker House 139/Trent Drive Duke University Medical Center; Durham, N.C. 27710;

©2009American Society of Plastic Surgeons