Multi-Modality Imaging for Head & Neck Cancer Free Flap Design Assessment
Multi-Modality Imaging for Head & Neck Cancer Free Flap Design Assessment
Surgical reconstruction of anatomical structures after head and neck cancer resection has
 made enormous strides in the past 20 years with advancing flap techniques and the usage of
 perforating vessels, but accurate and consistent identification of these perforators has
 remained a challenge due to the varying anatomy of vasculature in the donor region. Computed
 tomography angiography (CTA) has been used increasingly in preoperative free flap perforator
 mapping for breast reconstruction but has been limited in head and neck applications. In
 addition, indocyanine green (ICG) assisted NIR fluorescence angiography has been developed
 for intra-operative flap assessment. In this study, the investigators propose to assess a
 previously undocumented, multi-modal imaging technique with preoperative dual energy CTA to
 design and intraoperative ICG assisted NIR angiography to assess free flap in head and neck
 reconstruction.
CTA and NIR-assisted ICG angiography will be used in the mapping of the free flaps. CTA
 provides surgeons with preoperative information on the vascular anatomy and facilitates
 surgical planning for flap harvesting. The advantages of CTA are that it is noninvasive,
 rapid, and easy to read by the surgeon. Moreover, it provides information to help the surgeon
 decide which site to explore in the operation and reduces the rate of injuring or missing an
 optimal perforator.

 This technique can help reduce the size of the incision needed for perforator exploration,
 which helps reduce the patient's postoperative discomfort. The operation time can be reduced
 by choosing suitable perforators in the preoperative stage, which can also help reduce the
 cost of hospitalization. NIR-assisted angiography gives live localization of the flap's
 dominant perforator perfusion zones while quantifying the relative tissue perfusion for
 immediate skin paddle design.
Inclusion Criteria:

 -  The study will include patients planned for free anterolateral thigh/fibula or scapula
 flap for Head&Neck cancer reconstruction.

 -  The patients should have a complete and detailed medical record.

 -  Subjects must be at least 18 years of age.

 -  Subjects must sign and be given a copy of the written Informed Consent Form.

 Exclusion Criteria:

 -  Patients who are not able to consent by themselves or grasp the implication of the
 study.

 -  Subjects participating in any other clinical trial during the time of this clinical
 investigation and that may have an impact on this evaluation.

 -  Pregnant or potentially pregnant woman

 -  Lactation.

 -  Iodine, shellfish, cough mixture, betadine or ICG allergy

 -  The exclusion criteria for the IV contrast detailed in appendix 2.