Perfusion fluorometry, a method which quantifies tissue fluoresence after intravenous fluorescein injection, has been highly predictive of skin flap survival in animals. It is advantageous because it is objective, simple, noninvasive, repeatable, and can be used to monitor flap perfusion constantly by following both uptake and elimination of dye. We applied this method clinically to a variety of flaps used in head and neck surgery. All flaps with good fluorometric values survived totally. Based on experience with 37 flaps, fluorometric indices have been established that accurately predict necrosis. Serial dye injections have been used to document transient flap ischemia in the early postoperative period. Representative cases illustrating the advantages of fluorometry in flap assessment are presented.
SteinMRParkerCW. Reactions following intravenous fluorescein. Am J Ophthalmol1971; 72: 861–8.
3.
ArroyaveCMWolbersREllisPP. Plasma complement and histamine changes after intravenous administration of sodium fluorescein. Am J Ophthalmol1979; 87: 474–9.
4.
MyersMBBrockDCohnI. Prevention of skin slough after radical mastectomy by the use of a vital dye to delineate devascularized skin. Ann Surg1971; 173: 920–4.
5.
McCrawJBMyersBShanklinKD. The value of fluorescein in predicting the viability of arterialized flaps. Plast Reconstr Surg1973; 91: 526–8.
6.
SilvermanDGLaRossaDDBarlowCHBeringTGPopkyLMSmithTC. Quantification of tissue fluorescein delivery and prediction of flap viability with the fiberoptic dermofluorometer. Plast Reconstr Surg1980; 66: 545–53.
7.
GoodeRLLinehadJW. The fluorescein test in postirradiation surgery. Arch Otolaryngol1970; 91: 526–8.
8.
SingerRLewisCMFranklinJOLynchJB. Fluorescein test for prediction of flap viability during breast reconstructions. Plast Reconstr Surg1978; 61: 371–5.
9.
SilvermanDGHurfordWECooperHSRobinsonMBrousseauDA. Quantification of fluorescein distribution to strangulated rat ileum. J Surg Res1983; 34: 179–86.
10.
CarterMSFantiniGASammartanoRJMitsudoSSilvermanDGBoleySJ. Qualitative and quantitative fluorescein fluorescence for determining intestinal viability. Am J Surg1984; 147: 117–23.
11.
LangeKKrewerSE. The dermofluorometer. J Lab Clin Med1943; 28: 1746–51.
12.
SilvermanDGCedroneFAHurfordWEBeringTGLaRossaDD. Monitoring tissue elimination of fluorescein with the perfusion fluorometer: A new method to assess capillary blood flow. Surgery1981; 90: 409–17.
13.
WeismanRABlumbergALBrousseauDASilvermanDG. Fluorometric assessment of skin flap perfusion in the rat: Effect of radiation therapy. Otolaryngol Head Neck Surg1983; 91: 151–5.
14.
BrousseauDAKleinSKWeinstockBSSilvermanDG. Fluorometric assessment of perfusion in multicolored skin. Surg Forum1983; 34: 641–3.
15.
ChasseWRMinYGSilvermanDGBrousseauDAWeismanRA. Assessment of pedicle flap viability by fluorometry and laser Doppler. Surg Forum1983; 34: 579–81.
16.
SilvermanDGNortonKJBrousseauDA. Serial fluorometric documentation of fluorescein dye delivery. Surgery1985; 97: 185–92.
17.
HurfordWESilvermanDG. Evaluation of ischemic extremities by quantitative fluorescence assessment. Surg Forum1982; 33: 442–3.
18.
GattiJELaRossaDDNeffSRSilvermanDG. Altered skin flap survival and fluorescein kinetics with hemodilution. Surgery1982; 92: 200–5.
19.
VidasMCWeismanRASilvermanDG. Serial perfusion fluorometry in the assessment of experimental neurovascular island flaps. Arch Otolaryngol1983; 109: 457–62.
20.
SilvermanDGDennenyJBrousseauDAWeismanRA. Continuous monitoring of flap perfusion by fiberoptic fluorometry. Surg Forum1982; 33: 559–61.
21.
DennenyJCWeismanRASilvermanDG. Monitoring free flap perfusion by serial fluorometry. Otolaryngol Head Neck Surg1983; 91: 372–6.
22.
WeinbergHSongYSilvermanDGBeakSBrousseauDANortonKJ. Vascular island skin-flap tolerance to warm ischemia: An analysis by perfusion fluorometry. Plast Reconstr Surg1984; 73: 949–55.
23.
BuchananRTLevineNS. Blood pressure drop as a result of fluorescein injection. Plast Reconstr Surg1982; 70: 363–7.
24.
GattiJELaRossaDDSilvermanDG. Monitoring of neovascularization with fluorescein kinetics and microfil. Surg Forum1982; 33: 597–9.
25.
GattiJELaRossaDDBrousseauDASilvermanDG. Timing of assessment of neovascularization and flap division. Plast Reconstr Surg1984; 73: 396–402.
