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December 1993

Intravenous Fluorescein Vascularity Studies of a New Technique: The Subcutaneous Pedicled Extension Flap

Author Affiliations

Baltimore, Md
From the Fort Myers (Fla) Centre for Facial Plastic Surgery.

Arch Otolaryngol Head Neck Surg. 1993;119(12):1329-1337. doi:10.1001/archotol.1993.01880240065008

Objective:  To prove the vascularity of the subcutaneous pedicled extension flap through the subcutaneous pedicle. Second, the study was designed to reveal increasing vascularity as a function of time during the intraoperative period.

Design:  Twenty-six cases of flap utility are presented. The last 11 of these cases were tested for intraoperative vascularity using intravenous fluorescein sodium. Following a 1-mL (100-mg) fluorescein sodium test dose, an additional 900 mg was administered intraoperatively. The fluorescence was observed and photographed at 15-, 30-, and 60-minute intervals. The fluorescence (or lack thereof) was easily visible to the naked eye relative to the surrounding skin, requiring no specialized measurements. Photographic equipment consisted of a 35-mm camera with a UV filter, using 400 ASA—rated film at a 1-second timed setting. A tripod was necessary.

Setting:  All cases were performed in either an ambulatory surgical facility or an in-hospital facility.

Patients:  All patients suffered from skin cancer requiring large resections, necessitating reconstruction via either grafts or flaps.

Intervention:  Intravenous 10% fluorescein (Fluorescite) was used as a vascularity testing mode. The method was as described in the "Subjects and Methods" section.

Main Outcome Measures:  The results revealed conclusively the vascularity of the flap through the subcutaneous pedicle. In addition, the secondary goal, ie, of showing increasing vascularity with time, was also proved.

Results:  The subcutaneous flaps have survived in all cases, with minimal complications. The intravenous fluorescein test, with timed applications intraoperatively, has been reaffirmed as an excellent prognosticator of survivability, as well as a confirmation of the innate vascularity of the subcutaneous pedicle.

Conclusions:  The subcutaneous pedicled extension is thought to be a new development in random flaps. Its vascularity via the subcutaneous pedicle has been conclusively confirmed using the safe and simple intravenous fluorescein intraoperative study. Second, increasing fluorescence on a timed basis has been reaffirmed and this degree of vascularity related to the ease of survival of the flap.(Arch Otolaryngol Head Neck Surg. 1993;119:1329-1337)

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