Background:

During a DIEP Flap breast reconstruction surgery, a surgeon needs to know:

• if the selected epigastric perforators are adequately filling the entire flap prior to excising the abdominal tissue.
  
• if newly anastomosed vessels in the chest are filling and emptying briskly enough to avoid flap congestion which could cause fat necrosis and loss of the flap.
  
• if the subdermal plexus system fills to the outer edges of the flap indicating adequate perfusion to the skin.

Intra-Operative Imaging and Assessment:

Image Sequence 1
This image demonstrates flow to the subcutaneous side of the DIEP flap insitu. The Image demonstrates brisk filling of the perforator artery and vein and obvious perfusion throughout flap.

Image Sequence 1
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Image Sequence 2
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Image Sequence 2
This image sequence shows flow at the distal tip of the DIEP flap insitu. Intra-operative imaging demontrates subdermal plexus fluorescing quickly to the distal tip of the flap.

Image Sequence 3
Image shows an axillary shot of the anastomosis between DIEP artery and vein and thoraco-dorsal artery and vein. Good flow is demonstrated.

Image Sequence 3
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Image Sequence 4
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Image Sequence 4
This image sequence demonstrates the subdermal plexus fluorescing through the skin after skin closure. Note that flap and surrounding skin fill simultaneously.

Background:

During liver and kidney organ transplant, the surgeon needs to be able to:

• verify flow in newly constructed arteries and veins.
  
• verify perfusion of newly transplanted donor organ.
  
• verify function of new organ (eg. in a liver, the ICG should be seen in bile production indicating good function).

Intra-Operative Imaging and Assessment:

Liver transplant - Image Sequence 1
The image sequence demonstrates the diseased liver prior to excision.

Liver transplant - Image Sequence 1
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Liver transplant - Image Sequence 2
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Liver transplant - Image Sequence 2
Intra-operative imaging shows flow through the newly anastomosed hepatic artery (bifurcated into two lobes) and portal vein.

Liver transplant - Image Sequence 3
Image seqence provides view of the panning over the new liver. Image demonsrates a bruised area underneath the liver that pinked up later.

Liver transplant - Image Sequence 3
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Liver transplant - Image Sequence 4
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Liver transplant - Image Sequence 4
Image shows the tumor in an excised liver.

Kidney transplant - Image Sequence 1
The image sequence shows the kidney in a 56-year old, deceased donor after a long ischemic time.

Kidney transplant - Image Sequence 1
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Kidney transplant - Image Sequence 2
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Kidney transplant - Image Sequence 2
The image sequence shows the newly transplanted kidney from a deceased donor. The image demonstrates patchy perfusion which would improve over time, but patient was monitored very closely post-operatively.

Kidney transplant - Image Sequence 3
The image sequence demonstrates the newly transplanted kidney of a 20-year old, living donor. In this case, a son is donating his kidney to his father. This image demontrates flow in the kidney after a short ischemic time.

Kidney transplant - Image Sequence 3
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Kidney transplant - Image Sequence 4
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Kidney transplant - Image Sequence 4
Image sequence demonstrates a living donor kidney transplant. Even perfusion is seen over entire body of kidney.