Noninvasive intraoperative angiography for reconstruction of head and neck defects

Reconstruction of head and neck defects after cancer resection involves the use of local, pedicled musculocutaneous, and free flaps. Flap failure is often caused by vascular insufficiency, and it is associated with the presence of cardiovascular or peripheral vascular disease, a history of smoking, and previous radiation and/or surgery. Failure rates may be reduced by the use of indocyanine green near-infrared fluorescence laser angiography, which detects perfusion deficits intraoperatively. Although this technology has been validated in other fields, there is limited experience in the head and neck region. We present 3 cases in which different head and neck flaps were used along with this technology in patients at high risk for flap failure. All flaps were successfully implanted without perioperative or long-term complications. The increasing complexity, age, and comorbidities of the head and neck cancer population pose significant reconstructive challenges. This report demonstrates the feasibility of employing intraoperative angiography for local, pedicled, and free flaps. This noninvasive tool optimizes intraoperative planning and assesses viability, potentially lowering failure rates in high-risk patients. Identification of patients who most benefit from this technology warrants further investigation.