1.Objective: The primary objective of this study is to evaluate whether usage of intra-operative indocyanine green angiography can reduce post operative free flap complication
2.Material and Methods: A total of 121 patients with head and neck cancer with tumor wide excision and free flap reconstruction were included in our study, 61 patients using intra-operative ICG, doppler pen probe and physical examination for flap perfusion evaluation before pedicle ligation and after microscopic vascular anastomosis of the recipient vessel. Another 60 patients were evaluated with doppler pen probe and physical examination intraoperatively without ICG usage. Patients demographics including age, gender, tumor sites, cancer staging, previous radiotherapy, history of smoking, and albumin level were collected and analysis. Post operative complication were categorized into major and minor complication. Major complication including primary free flap failure with secondary reconstruction by local flap or free flap, and or flap salvage with re-anastomosis of vein or artery. Minor complication including wound infection, fistula formation, flap partial necrosis and wound hematoma requiring surgical treatment. The complication rate were analysis between two group.
3.Results: Patient demographics showing age and albumin level with significant difference(p<0.05). The minor complication rate and overall complication rate were significantly lower in ICG group(P<0.05). The major complication rate were lower in ICG group with obvious trend. In patient with history of pre-operative radiotherapy, minor complication rate was also lower in ICG group(p=0.038). All the patient in our study showing no adverse effect after ICG injection.
4.Conclusion: ICG angiography is a feasible and safe technique for the detection of flap perfusion intraoperatively. And with lower free flap complication rate by using ICG intraoperatively.

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