{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T02:54:21Z","timestamp":1784775261671,"version":"3.55.0"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,9,2]],"date-time":"2022-09-02T00:00:00Z","timestamp":1662076800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Free vascularized medial femoral condyle (MFC) bone grafts can lead to increased vascularity of the proximal pole and restore scaphoid architecture in scaphoid nonunions. The intraoperative perfusion assessment of the bone graft is challenging because the conventional clinical examination is difficult. Indocyanine green (ICG) angiography has previously been shown to provide a real-time intraoperative evaluation of soft tissue perfusion in reconstructive surgery. The present study investigated the utility of ICG angiography in patients treated with a free medial femoral condyle graft for scaphoid nonunions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed a retrospective analysis of patients with scaphoid nonunions, in which ICG angiography was used intraoperatively for perfusion assessment. The medical records, radiographs, intraoperative imaging, and operative reports of all patients were reviewed. Intraoperative ICG dye was administered intravenously, and laser angiography was performed to assess bone perfusion. The scaphoid union was examined using postoperative CT scans.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Two patients had documented osteonecrosis of the proximal pole at the time of surgery. Four patients received a nonvascularized prior bone graft procedure, and a prior spongiosa graft procedure was performed in one patient. The mean time from injury to the MFC bone graft surgery was 52.7 months, and the mean time from prior failed surgery was 10.4 months. Perfusion of the vascular pedicle of the MFC and the periosteum could be detected in all patients. In two patients, even perfusion of the cancellous bone could be demonstrated by ICG angiography. Following transplantation of the bone graft, patency of the vascular anastomosis and perfusion of the periost were confirmed by ICG angiography in the assessed cases. No additional surgery regarding a salvage procedure for a scaphoid nonunion advanced collapse was necessary for the further course.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>ICG-angiography has shown to be a promising tool in the treatment of scaphoid nonunion with medial femoral condyle bone grafts. It enables intraoperative decision making by assessment of the microvascular blood supply of the periosteum and the vascular pedicle of the MFC bone graft. Further studies need to evaluate the impact on union rates in a long-term follow-up.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2022.962450","type":"journal-article","created":{"date-parts":[[2022,9,2]],"date-time":"2022-09-02T05:37:24Z","timestamp":1662097044000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Does indocyanine green fluorescence angiography impact the intraoperative choice of procedure in free vascularized medial femoral condyle grafting for scaphoid nonunions?"],"prefix":"10.3389","volume":"9","author":[{"given":"Markus","family":"Mulica","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymund E.","family":"Horch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Arkudas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aijia","family":"Cai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wibke","family":"M\u00fcller-Seubert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theresa","family":"Hauck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingo","family":"Ludolph","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,9,2]]},"reference":[{"key":"B1","first-page":"861","article-title":"Scaphoid fractures and scaphoid nonunion. Diagnosis and treatment","volume":"23","author":"Kuschner","year":"1994","journal-title":"Orthop Rev"},{"key":"B2","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1053\/jhsu.2002.34372","article-title":"Treatment of scaphoid nonunions: quantitative meta-analysis of the literature","volume":"27","author":"Merrell","year":"2002","journal-title":"J Hand Surg Am"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1666","DOI":"10.1097\/01.PRS.0000086090.43085.66","article-title":"Scaphoid nonunion: diagnosis and treatment","volume":"112","author":"Pao","year":"2003","journal-title":"Plast Reconstr Surg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"2616","DOI":"10.2106\/JBJS.G.01503","article-title":"Treatment of scaphoid waist nonunions with an avascular proximal pole and carpal collapse. A comparison of two vascularized bone grafts","volume":"90","author":"Jones","year":"2008","journal-title":"J Bone Joint Surg Am"},{"key":"B5","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1186\/1749-799X-9-21","article-title":"The use of the free vascularised bone graft for nonunion of the scaphoid: a systematic review","volume":"9","author":"Al-Jabri","year":"2014","journal-title":"J Orthop Surg Res"},{"key":"B6","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1016\/j.jhsa.2005.10.019","article-title":"The outcomes and complications of 1,2-intercompartmental supraretinacular artery pedicled vascularized bone grafting of scaphoid nonunions","volume":"31","author":"Chang","year":"2006","journal-title":"J Hand Surg Am"},{"key":"B7","doi-asserted-by":"publisher","first-page":"848","DOI":"10.1177\/1753193414561900","article-title":"Vascularized medial femoral condyle graft for management of scaphoid nonunion","volume":"40","author":"Elgammal","year":"2015","journal-title":"J Hand Surg Eur Vol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"507","DOI":"10.1053\/jhsu.2000.5993","article-title":"Free vascularized bone graft for nonunion of the scaphoid","volume":"25","author":"Doi","year":"2000","journal-title":"J Hand Surg Am"},{"key":"B9","doi-asserted-by":"publisher","first-page":"138","DOI":"10.4103\/ijps.IJPS_62_17","article-title":"Medial femoral condyle vascularised corticoperiosteal graft: a suitable choice for scaphoid nonunion","volume":"50","author":"Kumta","year":"2017","journal-title":"Indian J Plast Surg"},{"key":"B10","doi-asserted-by":"publisher","first-page":"396","DOI":"10.1007\/s00064-009-1902-5","article-title":"Das freie mikrovaskul\u00e4re Knochentransplantat vom medialen Femurkondylus zur Behandlung der Kahnbeinpseudarthrose","volume":"21","author":"B\u00fcrger","year":"2009","journal-title":"Oper Orthop Traumatol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1176","DOI":"10.1097\/PRS.0b013e3181d1808c","article-title":"Free-vascularized medial femoral condyle bone transfer in the treatment of scaphoid nonunions","volume":"125","author":"Jones","year":"2010","journal-title":"Plast Reconstr Surg"},{"key":"B12","doi-asserted-by":"publisher","first-page":"597","DOI":"10.1016\/S0363-5023(85)80191-X","article-title":"The effect of avascular necrosis on Russe bone grafting for scaphoid nonunion","volume":"10","author":"Green","year":"1985","journal-title":"J Hand Surg Am"},{"key":"B13","doi-asserted-by":"publisher","first-page":"39","DOI":"10.3389\/fsurg.2019.00039","article-title":"Enhancing safety in reconstructive microsurgery using intraoperative indocyanine green angiography","volume":"6","author":"Ludolph","year":"2019","journal-title":"Front Surg"},{"key":"B14","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1055\/s-0031-1281515","article-title":"The application of indocyanine green fluorescence angiography in plastic surgery","volume":"27","author":"Liu","year":"2011","journal-title":"J Reconstr Microsurg"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1095","DOI":"10.1016\/j.jhsa.2012.03.002","article-title":"Management of scaphoid nonunion","volume":"37","author":"Buijze","year":"2012","journal-title":"J Hand Surg Am"},{"key":"B16","doi-asserted-by":"publisher","first-page":"246","DOI":"10.1097\/bth.0b013e3180cab17c","article-title":"Free medial femoral condyle bone grafting for scaphoid nonunions with humpback deformity and proximal pole avascular necrosis","volume":"11","author":"Larson","year":"2007","journal-title":"Tech Hand Up Extrem Surg"},{"key":"B17","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1016\/0363-5023(91)90017-6","article-title":"A new vascularized bone graft for scaphoid nonunion","volume":"16","author":"Zaidemberg","year":"1991","journal-title":"J Hand Surg Am"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1379","DOI":"10.2106\/JBJS.17.00955","article-title":"Free vascularized medial femoral condyle bone graft after failed scaphoid nonunion surgery","volume":"100","author":"Pulos","year":"2018","journal-title":"J Bone Joint Surg Am"},{"key":"B19","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1016\/S0094-1298(03)00036-1","article-title":"Doppler sonography and color duplex imaging for planning a perforator flap","volume":"30","author":"Hallock","year":"2003","journal-title":"Clin Plast Surg"},{"key":"B20","doi-asserted-by":"publisher","first-page":"942","DOI":"10.1111\/iwj.13683","article-title":"Response to the letter to the editor \u2018novel imaging methods reveal positive impact of topical negative pressure application on tissue perfusion in an in-vivo skin model\u2019","volume":"18","author":"Muller-Seubert","year":"2021","journal-title":"Int Wound J"},{"key":"B21","doi-asserted-by":"publisher","first-page":"2","DOI":"10.3390\/jpm12020237","article-title":"Intra- and early postoperative evaluation of malperfused areas in an irradiated random pattern skin flap model using indocyanine green angiography and near-infrared reflectance-based imaging and infrared thermography","volume":"12","author":"Muller-Seubert","year":"2022","journal-title":"J Pers Med"},{"key":"B22","doi-asserted-by":"publisher","first-page":"3","DOI":"10.3390\/jpm12030482","article-title":"Intraoperative blood flow analysis of DIEP vs. Ms-TRAM flap breast reconstruction combining transit-time flowmetry and microvascular indocyanine green angiography","volume":"12","author":"Geierlehner","year":"2022","journal-title":"J Pers Med"},{"key":"B23","doi-asserted-by":"publisher","first-page":"e43","DOI":"10.1016\/j.jss.2012.05.014","article-title":"Bone flap perfusion assessment using near-infrared fluorescence imaging","volume":"178","author":"Nguyen","year":"2012","journal-title":"J Surg Res"},{"key":"B24","doi-asserted-by":"publisher","first-page":"e1570","DOI":"10.1097\/GOX.0000000000001570","article-title":"Feasibility of bone perfusion evaluation in cadavers using indocyanine green fluorescence angiography","volume":"5","author":"Yoshimatsu","year":"2017","journal-title":"Plast Reconstr Surg Glob Open"},{"key":"B25","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1097\/00005131-198906000-00009","article-title":"An experimental study of the patterns of periosteal and endosteal damage in tibial shaft fractures using a rabbit trauma model","volume":"3","author":"Oni","year":"1989","journal-title":"J Orthop Trauma"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1382","DOI":"10.1016\/j.bjps.2016.07.014","article-title":"Cracking the perfusion code: laser-assisted indocyanine green angiography and combined laser Doppler spectrophotometry for intraoperative evaluation of tissue perfusion in autologous breast reconstruction with DIEP or ms-TRAM flaps","volume":"69","author":"Ludolph","year":"2016","journal-title":"J Plast Reconstr Aesthet Surg"},{"key":"B27","doi-asserted-by":"publisher","first-page":"684","DOI":"10.1002\/micr.22424","article-title":"Intraoperative flap design using ICG monitoring of a conjoined fabricated anterolateral thigh\/tensor fasciae latae perforator flap in a case of extensive soft tissue reconstruction at the lower extremity","volume":"36","author":"Buehrer","year":"2016","journal-title":"Microsurgery"},{"key":"B28","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1515\/bmt-2017-0155","article-title":"Hyperspectral imaging in perfusion and wound diagnostics - methods and algorithms for the determination of tissue parameters","volume":"63","author":"Holmer","year":"2018","journal-title":"Biomed Tech (Berl)"},{"key":"B29","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1055\/s-0028-1090617","article-title":"The application of laser-assisted indocyanine green fluorescent dye angiography in microsurgical breast reconstruction","volume":"25","author":"Newman","year":"2009","journal-title":"J Reconstr Microsurg"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2022.962450\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,23]],"date-time":"2023-01-23T11:19:00Z","timestamp":1674472740000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2022.962450\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,2]]},"references-count":29,"alternative-id":["10.3389\/fsurg.2022.962450"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2022.962450","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,2]]},"article-number":"962450"}}