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Eiger et al: Use of near‐infrared fluorescence angiography with indocyanine green to evaluate direct cutaneous arteries used for canine axial pattern flaps
Veterinary Surgery 6, 2024

🔍 Key Findings

  • Caudal superficial epigastric (CSE) flaps were most visible with NIRFA, scoring 4/4 VFP in 97% of evaluations.
  • CSE flap margins were altered in 65% of observations after NIRFA, showing the strongest influence on surgical planning.
  • Thoracodorsal (THO) and omocervical (OMO) flaps had lower visualization scores, with 60–81% of images scoring below 2.
  • Surgeons were 17–25 times more likely to adjust margins for CSE flaps versus OMO or THO based on fluorescence imaging.
  • Poor inter-rater agreement was found for OMO (ICC 0.49) and THO (ICC 0.35); CSE had near-perfect agreement, but ICC was low due to uniform high scoring.
  • Visualization was affected by flap depth and panniculus, making deeper vessels (OMO, THO) harder to see.
  • Surgeons often shortened flap length and reduced flap area when modifying based on NIRFA results.
  • Real-time angiosome visualization via NIRFA-ICG may reduce necrosis risk and improve patient-specific APF design.

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← Articles

Eiger et al: Use of near‐infrared fluorescence angiography with indocyanine green to evaluate direct cutaneous arteries used for canine axial pattern flaps
Veterinary Surgery 6, 2024

🔍 Key Findings

  • Caudal superficial epigastric (CSE) flaps were most visible with NIRFA, scoring 4/4 VFP in 97% of evaluations.
  • CSE flap margins were altered in 65% of observations after NIRFA, showing the strongest influence on surgical planning.
  • Thoracodorsal (THO) and omocervical (OMO) flaps had lower visualization scores, with 60–81% of images scoring below 2.
  • Surgeons were 17–25 times more likely to adjust margins for CSE flaps versus OMO or THO based on fluorescence imaging.
  • Poor inter-rater agreement was found for OMO (ICC 0.49) and THO (ICC 0.35); CSE had near-perfect agreement, but ICC was low due to uniform high scoring.
  • Visualization was affected by flap depth and panniculus, making deeper vessels (OMO, THO) harder to see.
  • Surgeons often shortened flap length and reduced flap area when modifying based on NIRFA results.
  • Real-time angiosome visualization via NIRFA-ICG may reduce necrosis risk and improve patient-specific APF design.

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Multiple Choice Questions on this study

In Eiger 2024 et al., on NIRFA-ICG in axial flaps, what was the typical direction of margin adjustment surgeons made after viewing NIRFA-ICG images?

A. Lengthening flap and widening margins
B. Shifting flap distally only
C. Increasing area and length in all cases
D. Shortening flap length and decreasing area
E. No consistent trend observed

Answer: Shortening flap length and decreasing area

Explanation: Surgeons most often shortened flaps and reduced area after visualizing perfusion zones with NIRFA.
In Eiger 2024 et al., on NIRFA-ICG in axial flaps, which flap had the highest visibility score (VFP 4) across all surgeons?

A. Omocervical (OMO)
B. Thoracodorsal (THO)
C. Caudal superficial epigastric (CSE)
D. Pectoral
E. Deep circumflex iliac

Answer: Caudal superficial epigastric (CSE)

Explanation: 97% of CSE flap observations scored VFP 4/4, indicating the highest clarity using NIRFA-ICG.
In Eiger 2024 et al., on NIRFA-ICG in axial flaps, what limitation most affected the visibility of OMO and THO flaps compared to CSE?

A. Improper ICG dosing
B. Patient motion during imaging
C. Ambient light overexposure
D. Deeper location of vasculature
E. Incorrect clipping technique

Answer: Deeper location of vasculature

Explanation: OMO and THO vessels were deeper and often beneath panniculus, decreasing NIRFA visibility.
In Eiger 2024 et al., on NIRFA-ICG in axial flaps, how did inter-rater reliability (ICC) compare between evaluated flaps for VFP scoring?

A. CSE highest, ICC >0.8; THO lowest, ICC <0.2
B. OMO highest, ICC >0.9; THO lowest, ICC <0.3
C. CSE lowest ICC due to uniform scores; OMO and THO moderate
D. THO and OMO both >0.75, CSE <0.3
E. All flaps showed similarly poor ICC

Answer: CSE lowest ICC due to uniform scores; OMO and THO moderate

Explanation: CSE had low ICC (0.09) due to all surgeons scoring 4/4, while OMO and THO had moderate inter-rater variability.
In Eiger 2024 et al., on NIRFA-ICG in axial flaps, what percentage of CSE flap evaluations led to margin changes based on NIRFA visualization?

A. 20%
B. 35%
C. 50%
D. 65%
E. 85%

Answer: 65%

Explanation: Margins for the CSE flap were changed in 65% of evaluations after viewing NIRFA-ICG images.

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