A technique for safe deep facial tissue dissection: Indocyanine green–assisted intraoperative real-time visualization of the vasa nervorum of facial nerve with a near-infrared camera

Deep-plane facelift technique for managing extensive hemifacial tumors: A retrospective study

This study aimed to evaluate functional and aesthetic outcomes in patients undergoing deep-plane facelifts for the management of extensive hemifacial tumors. The retrospective study included patients who had been diagnosed with benign tumors with extensive hemifacial involvement. All patients underwent tumor debulking via a dual-plane facelift approach, assisted by an ICG camera to visualize the facial nerve structures. To manage the laxity of the skin envelope, the deep-plane face-lift was performed by suspending the superficial musculoaponeurotic layer, followed by suture fixation to the parotid-masseteric fascia. Clinical outcomes, including complications, House-Brackmann grading for facial paralysis, and tumor recurrence rate were investigated. Quantitative facial nerve examination was carried out using FACE-gram software (Massachusetts Eye and Ear Infirmary, Boston, USA) to measure mouth corner movement at rest and when smiling. Using preoperative and 1-year postoperative 3D photographs, facial symmetry was assessed using comparisons of facial volume and the root-mean-square deviation (RMSD) value to represent the height difference between each hemiface. In total, 25 patients who met the inclusion criteria were recruited to the study. Regarding the types of tumor, 13 of the 25 patients were diagnosed with vascular lesions and the other 12 with neurofibromatosis plexiform. Following surgery, two patients showed temporary palsy of the buccal branches - grade II on the House-Brackmann scale - but neural functioning was eventually restored during the follow-up period. During resting, the mouth corner excursion ratio was significantly improved, from 1.11 ± 0.19 preoperatively to 1.02 ± 0.08 postoperatively (p = 0.022). The facial volume ratio was significantly improved in the lower face, from 1.57 ± 0.66 preoperatively to 1.19 ± 0.18 postoperatively (p = 0.008). The RMSD was significantly decreased, from 4.56 ± 2.35 mm preoperatively to 2.08 ± 0.99 mm postoperatively (p < 0.001), representing a decrease in facial asymmetry. Within the limitations of the study, it seems that the ICG camera-assisted deep-plane facelift technique allows preservation of facial nerve functioning and enhances facial symmetry when managing extensive hemifacial tumors.

Indocyanine Green for Leakage Control in Isolated Limb Perfusion

Sarcomas are characterized by a high metastatic potential and aggressive growth. Despite surgery, chemotherapy plays an important role in the treatment of these tumors. Optimal anti-cancer therapy with maximized local efficacy and minimized systemic side effects has been the object of many studies for a long time. To improve the local efficacy of anti-tumor therapy, isolated limb perfusion with high-dose cytostatic agents has been introduced in surgical oncology. In order to control the local distribution of substances, radiolabeled cytostatic drugs or perfusion solutions have been applied but often require the presence of specialized personnel and result in a certain exposure to radiation. In this study, we present a novel strategy using indocyanine green to track tumor perfusion with high-dose cytostatic therapy. In a rat cadaver model, the femoral vessels were cannulated and connected to a peristaltic pump to provide circulation within the selected limb. The perfusion solution contained indocyanine green and high-dose doxorubicin. An infrared camera enabled the visualization of indocyanine green during limb perfusion, and subsequent leakage control was successfully performed. Histologic analysis of sections derived proximally from the injection site excluded systemic drug dispersion. In this study, the application of indocyanine green was proven to be a safe and cost- and time-efficient method for precise leakage control in isolated limb perfusion with a high-dose cytostatic agent.

The Use of Indocyanine Green Angiography for Cosmetic and Reconstructive Assessment in the Head and Neck

Reconstructive procedures in the head and neck can be a surgical challenge owing to the complex anatomical and physiological structure. Different locoregional and microvascular flaps are used for various defects to improve both function and cosmesis. Subjective clinical findings have been the mainstay for perfusion monitoring; however, areas of borderline perfusion are much more difficult to assess clinically. Multiple technologies that offer objective perfusion assessment have been developed to improve surgical outcomes. Indocyanine green (ICG) angiography has gained popularity owing to its minimal invasiveness and increased sensitivity and specificity in assessing flap perfusion particularly in the head and neck. It has been extensively used in free flaps, pedicled flaps (including nasal reconstruction), facelift procedures, random flaps, skull base reconstruction, and pharyngocutaneous fistula prediction. Its perioperative use has provided valuable qualitative and quantitative data that aid our understanding of flap hemodynamics. Clinically, this impacted decision-making in flap design, harvest, inset, and precocious salvage interventions. Though increased cost and intraoperative time could be limitations, cost-effectiveness studies have supported its use, particularly in high-risk individuals. Limitations include the lack of standardized dosing and consistent methodology agreement for data analysis. Future studies should involve larger cohorts and multi-institute studies to overcome such limitations.