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Prefabricated Cervical Skin Flaps for Hemi-Facial Resurfacing: Elucidating the Natural History of Postoperative Edema Using Indocyanine Green. | LitMetric

AI Article Synopsis

  • The study investigates the causes of swelling (edema) in prefabricated skin flaps used for facial burns, highlighting both capillary changes and potential lymphatic disruption as contributing factors.
  • It monitored 18 patients post-surgery, recording the time for edema resolution, presence of venous congestion, and flap outcomes, employing indocyanine-green (ICG) lymphography in some cases to track lymphatic recovery.
  • Results indicated a significant improvement in lymphatic function over time, with edema considered to mainly arise from lymphatic disruptions that improve as new lymphatic channels develop, suggesting ICG lymphography can effectively track post-surgical lymphedema.

Article Abstract

Background: The increases in capillary wall permeability and capillary hydrostatic pressure are considered to be the causes for the acute swelling seen in flaps; however, disruption of the circulating flap lymphatics could be another contributory factor. In this study we monitor the development of flap edema in a series of 18 prefabricated flaps and aim to delineate the natural history of this phenomenon by use of lymphography.

Methods: Postoperative swelling was monitored in a series of 18 pre-expanded prefabricated cervical skin flaps used for hemi-facial burns-scar resurfacing. Time to spontaneous resolution, presence or absence of venous congestion, and clinical outcome were recorded. In two cases, indocyanine-green (ICG) lymphography was used to monitor the dermal backflow pattern until swelling had completely resolved. Average moving velocity of ICG after injection as well as flap thickness was also recorded over the follow-up period.

Results: The average moving velocity of ICG in the flap lymphatics improved from 0.48 cm/min to 1.5 cm/min in the first 12 days after flap transfer. The dermal backflow pattern was stardust in the first 12 days, indicating moderate lymphedema, transforming to splash from week three, and a robust collecting lymphatic vessel occurring from the fifth month, indicating mild lymphedema and lymphatic channel recovery, respectively.

Conclusion: Transient swelling was observed in all prefabricated flaps in our series. We postulate that this is mostly secondary to lymphatic disruption that subsides as lymphangiogenesis takes place. ICG lymphography is an inexpensive, safe, and easy-to-use imaging technology that could be used in the monitoring of postoperative lymphedema seen in prefabricated flaps.

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Source
http://dx.doi.org/10.1089/lrb.2015.0043DOI Listing

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