{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T12:23:45Z","timestamp":1790771025683,"version":"4.1.0"},"reference-count":9,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2017,9,1]],"date-time":"2017-09-01T00:00:00Z","timestamp":1504224000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["JAMA Facial Plast Surg"],"published-print":{"date-parts":[[2017,9]]},"abstract":"\n Importance<\/jats:title>\n The paramedian forehead flap is considered the gold standard procedure to optimally reconstruct major defects of the nose, but this procedure generally requires 2 stages, where the flap pedicle is divided 3 weeks following the initial surgery to ensure adequate revascularization of the flap from the surrounding recipient tissue bed, which can cost a patient time out of work or away from normal social habits. It has previously been shown that the pedicle may be safely divided after 2 weeks in select patients where revascularization from the recipient bed was confirmed using intraoperative laser fluorescence angiography to potentially save the patient time and money.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To demonstrate the cost-effectiveness of takedown of the paramedian forehead flap pedicle after 2 weeks using angiography with indocyanine green (ICG).<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n Retrospective cohort study of all patients who underwent 2-week division of the forehead flap after nasal reconstruction. Patient, tumor, defect, and outcomes data were collected. Cost-minimization analysis was performed by comparing the overall costs of 2-week takedown with angiography to a hypothetical patient undergoing 3-week takedown without angiography.<\/jats:p>\n <\/jats:sec>\n \n Intervention<\/jats:title>\n Two-week division of the forehead flap after nasal reconstruction.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Cost-minimization analysis performed by calculating the total variable costs for a patient in our cohort vs costs to a theoretical patient for whom angiography was not performed and the pedicle was divided at the 3-week mark.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 22 patients were included (mean [SD] age, 70.3 [10.0] years; 8 women [36.4%] and 14 men [63.6%]). The selection criteria for 2-week division of the pedicle are a wound bed with at least 50% vascularized tissue present, partial-thickness defects, and absence of nicotine use. All were divided at the 2-week mark with no instances of flap necrosis. One patient had a squamous eccrine carcinoma histology before reconstruction, all other patients had basal cell carcinoma, squamous cell carcinoma, and melanoma. Cost-minimization analysis showed that the use of angiography with ICG results in cost savings of $177 per patient on average.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n Two-week takedown of select paramedian forehead flap patients can be performed safely with verification using angiography with ICG. Although this technology inherently adds cost, it is cost-effective, saving a total of $177 per patient.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence<\/jats:title>\n \n NA<\/jats:ext-link>\n .\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamafacial.2017.0310","type":"journal-article","created":{"date-parts":[[2017,6,1]],"date-time":"2017-06-01T12:32:14Z","timestamp":1496320334000},"page":"418-420","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":28,"title":["Cost-effectiveness of Early Division of the Forehead Flap Pedicle"],"prefix":"10.1177","volume":"19","author":[{"given":"Hollin E.","family":"Calloway","sequence":"first","affiliation":[{"name":"Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology\u2013Head and Neck Surgery, Stanford University School of Medicine, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sami P.","family":"Moubayed","sequence":"additional","affiliation":[{"name":"Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology\u2013Head and Neck Surgery, Stanford University School of Medicine, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sam P.","family":"Most","sequence":"additional","affiliation":[{"name":"Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology\u2013Head and Neck Surgery, Stanford University School of Medicine, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2017,9,21]]},"reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0033-1351231"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-200205000-00010"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamafacial.2015.0171"},{"issue":"6","key":"e_1_3_1_5_2","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1016\/S0305-4179(98)80004-1","article-title":"Detection of capillary protein leakage by glucose and indocyanine green dilutions during the early post-burn period","volume":"24","author":"Ishihara H","year":"1998","unstructured":"Ishihara H, , Otomo N, , Suzuki A, , Takamura K, , Tsubo T, , Matsuki A. Detection of capillary protein leakage by glucose and indocyanine green dilutions during the early post-burn period. Burns. 1998; 24(6):525-531. 9776091","journal-title":"Burns"},{"key":"e_1_3_1_6_2","volume-title":"Cost Effectiveness in Health and Medicine","author":"Ganiats TG","year":"2017","unstructured":"Ganiats TG, , Neumann PJ, , Russell LB, , Sanders GD, , Siegel JE. Cost Effectiveness in Health and Medicine. Second ed. Oxford; New York: Oxford University Press; 2017."},{"issue":"4","key":"e_1_3_1_7_2","doi-asserted-by":"crossref","first-page":"448e","DOI":"10.1097\/PRS.0000000000000025","article-title":"Whom should we SPY? a cost analysis of laser-assisted indocyanine green angiography in prevention of mastectomy skin flap necrosis during prosthesis-based breast reconstruction","volume":"133","author":"Kanuri A","year":"2014","unstructured":"Kanuri A, , Liu AS, , Guo L. Whom should we SPY? a cost analysis of laser-assisted indocyanine green angiography in prevention of mastectomy skin flap necrosis during prosthesis-based breast reconstruction. Plast Reconstr Surg. 2014; 133(4):448e-454e. 24675199","journal-title":"Plast Reconstr Surg"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1001\/archfaci.2011.1540"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2015.1187"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.fsc.2012.07.004"}],"container-title":["JAMA Facial Plastic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1001\/jamafacial.2017.0310","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1001\/jamafacial.2017.0310","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1001\/jamafacial.2017.0310","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T06:25:23Z","timestamp":1777443923000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1001\/jamafacial.2017.0310"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,9]]},"references-count":9,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2017,9]]}},"alternative-id":["10.1001\/jamafacial.2017.0310"],"URL":"https:\/\/doi.org\/10.1001\/jamafacial.2017.0310","relation":{},"ISSN":["2168-6076","2168-6092"],"issn-type":[{"value":"2168-6076","type":"print"},{"value":"2168-6092","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,9]]}}}