ArticleJPRAS open2026
Indocyanine green near-infrared fluorescence angiography in free parascapular flaps: Distal flap perfusion assessment in a retrospective study of 112 cases.
Article in JPRAS open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Reliable perfusion of the distal portion of free parascapular (PSC) flaps is essential for successful lower extremity reconstruction. We hypothesized that intraoperative indocyanine green near-infrared video angiography (ICG-NIR-VA) enables reliable assessment of distal flap perfusion, thereby supporting microsurgical decision-making and reducing the risk of distal flap necrosis. Methods: We conducted a retrospective analysis of all free parascapular (PSC) flaps performed for lower extremity reconstruction between January 2015 and December 2024. Patients were non-randomly assigned to intraoperative perfusion assessment using indocyanine green near-infrared video angiography (ICG-NIR-VA; study group, n = 45) or conventional clinical evaluation (control group, n = 67). In both groups, inadequately perfused flap segments were trimmed intraoperatively at the surgeon's discretion. Primary endpoints were distal or total flap necrosis, while secondary outcomes included reoperation rates and postoperative length of hospital stay (POLHS. Results: Intraoperative use of ICG-NIR-VA guided PSC flap design by identifying poorly perfused distal flap portions in 15 of 45 cases (33%), all of which resulted in uncomplicated postoperative courses. Partial flap necrosis occurred in 3 of 45 flaps (6.7%) in the ICG-NIR-VA group compared to 12 of 67 flaps (18.0%) in the control group (p = 0.09). Overall, intraoperative ICG-NIR-VA showed a strong correlation with postoperative outcomes, reflected by a negative predictive value of 98%. Furthermore, ICG-NIR-VA-assisted reconstructions required fewer recipient-site revision surgeries (9/45 [20.0%] vs. 24/67 [35.8%], p = 0.10) and showed a non-significant trend toward a shorter postoperative length of hospital stay (19 ± 10 vs. 21 ± 11 days, p = 0.40). Conclusions: Our findings suggest that ICG-NIR-VA may support intraoperative decision-making and may be associated with improved clinical outcomes, although several observed differences did not reach statistical significance.
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