Objective Perfusion Assessment in Gracilis Muscle Interposition—A Novel Software-Based Approach to Indocyanine Green Derived Near-Infrared Fluorescence in Reconstructive Surgery
Background: Gracilis muscle interposition (GMI) is an established treatment option for complex perineal fistulas and reconstruction. The outcome is limited by complications such as necrosis, impaired wound healing and fistula persistence or recurrence. Quantifiable methods of assessing muscle flap p...
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| Format: | Article |
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MDPI AG
2022-02-01
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| Series: | Life |
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| Online Access: | https://www.mdpi.com/2075-1729/12/2/278 |
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| author | Leonard A. Lobbes Richelle J. M. Hoveling Leonard R. Schmidt Susanne Berns Benjamin Weixler |
| author_facet | Leonard A. Lobbes Richelle J. M. Hoveling Leonard R. Schmidt Susanne Berns Benjamin Weixler |
| author_sort | Leonard A. Lobbes |
| collection | DOAJ |
| description | Background: Gracilis muscle interposition (GMI) is an established treatment option for complex perineal fistulas and reconstruction. The outcome is limited by complications such as necrosis, impaired wound healing and fistula persistence or recurrence. Quantifiable methods of assessing muscle flap perfusion intraoperatively are lacking. This study evaluates a novel and objective software-based assessment of indocyanine green near-infrared fluorescence (ICG-NIRF) in GMI. Methods: Intraoperative ICG-NIRF visualization data of five patients with inflammatory bowel disease (IBD) undergoing GMI for perineal fistula and reconstruction were analyzed retrospectively. A new software was utilized to generate perfusion curves for the specific regions of interest (ROIs) of each GMI by depicting the fluorescence intensity over time. Additionally, a pixel-to-pixel and perfusion zone analysis were performed. The findings were correlated with the clinical outcome. Results: Four patients underwent GMI without postoperative complications within 3 months. The novel perfusion indicators identified here (shape of the perfusion curve, maximum slope value, distribution and range) indicated adequate perfusion. In one patient, GMI failed. In this case, the perfusion indicators suggested impaired perfusion. Conclusions: We present a novel, software-based approach for ICG-NIRF perfusion assessment, identifying previously unknown objective indicators of muscle flap perfusion. Ready for intraoperative real-time use, this method has considerable potential to optimize GMI surgery in the future. |
| first_indexed | 2024-03-09T21:34:34Z |
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| issn | 2075-1729 |
| language | English |
| last_indexed | 2024-03-09T21:34:34Z |
| publishDate | 2022-02-01 |
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| spelling | doaj.art-b305e3e32b9c4a4cbfadbd67ca0ad4dc2023-11-23T20:46:51ZengMDPI AGLife2075-17292022-02-0112227810.3390/life12020278Objective Perfusion Assessment in Gracilis Muscle Interposition—A Novel Software-Based Approach to Indocyanine Green Derived Near-Infrared Fluorescence in Reconstructive SurgeryLeonard A. Lobbes0Richelle J. M. Hoveling1Leonard R. Schmidt2Susanne Berns3Benjamin Weixler4Department of General and Visceral Surgery, Hindenburgdamm 30, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12203 Berlin, GermanyQuest Medical Imaging, 1775 PW Middenmeer, The NetherlandsDepartment of General and Visceral Surgery, Hindenburgdamm 30, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12203 Berlin, GermanyDepartment of General and Visceral Surgery, Hindenburgdamm 30, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12203 Berlin, GermanyDepartment of General and Visceral Surgery, Hindenburgdamm 30, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12203 Berlin, GermanyBackground: Gracilis muscle interposition (GMI) is an established treatment option for complex perineal fistulas and reconstruction. The outcome is limited by complications such as necrosis, impaired wound healing and fistula persistence or recurrence. Quantifiable methods of assessing muscle flap perfusion intraoperatively are lacking. This study evaluates a novel and objective software-based assessment of indocyanine green near-infrared fluorescence (ICG-NIRF) in GMI. Methods: Intraoperative ICG-NIRF visualization data of five patients with inflammatory bowel disease (IBD) undergoing GMI for perineal fistula and reconstruction were analyzed retrospectively. A new software was utilized to generate perfusion curves for the specific regions of interest (ROIs) of each GMI by depicting the fluorescence intensity over time. Additionally, a pixel-to-pixel and perfusion zone analysis were performed. The findings were correlated with the clinical outcome. Results: Four patients underwent GMI without postoperative complications within 3 months. The novel perfusion indicators identified here (shape of the perfusion curve, maximum slope value, distribution and range) indicated adequate perfusion. In one patient, GMI failed. In this case, the perfusion indicators suggested impaired perfusion. Conclusions: We present a novel, software-based approach for ICG-NIRF perfusion assessment, identifying previously unknown objective indicators of muscle flap perfusion. Ready for intraoperative real-time use, this method has considerable potential to optimize GMI surgery in the future.https://www.mdpi.com/2075-1729/12/2/278indocyanine greenICGnear-infrared fluorescenceperfusion assessmentgracilis muscle interpositionGMI |
| spellingShingle | Leonard A. Lobbes Richelle J. M. Hoveling Leonard R. Schmidt Susanne Berns Benjamin Weixler Objective Perfusion Assessment in Gracilis Muscle Interposition—A Novel Software-Based Approach to Indocyanine Green Derived Near-Infrared Fluorescence in Reconstructive Surgery Life indocyanine green ICG near-infrared fluorescence perfusion assessment gracilis muscle interposition GMI |
| title | Objective Perfusion Assessment in Gracilis Muscle Interposition—A Novel Software-Based Approach to Indocyanine Green Derived Near-Infrared Fluorescence in Reconstructive Surgery |
| title_full | Objective Perfusion Assessment in Gracilis Muscle Interposition—A Novel Software-Based Approach to Indocyanine Green Derived Near-Infrared Fluorescence in Reconstructive Surgery |
| title_fullStr | Objective Perfusion Assessment in Gracilis Muscle Interposition—A Novel Software-Based Approach to Indocyanine Green Derived Near-Infrared Fluorescence in Reconstructive Surgery |
| title_full_unstemmed | Objective Perfusion Assessment in Gracilis Muscle Interposition—A Novel Software-Based Approach to Indocyanine Green Derived Near-Infrared Fluorescence in Reconstructive Surgery |
| title_short | Objective Perfusion Assessment in Gracilis Muscle Interposition—A Novel Software-Based Approach to Indocyanine Green Derived Near-Infrared Fluorescence in Reconstructive Surgery |
| title_sort | objective perfusion assessment in gracilis muscle interposition a novel software based approach to indocyanine green derived near infrared fluorescence in reconstructive surgery |
| topic | indocyanine green ICG near-infrared fluorescence perfusion assessment gracilis muscle interposition GMI |
| url | https://www.mdpi.com/2075-1729/12/2/278 |
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