Intraoperative laser-assisted indocyanine green angiography for the evaluation of mastectomy flaps in immediate breast reconstruction.
Skin-sparing mastectomy has been associated with flap ischemia and necrosis. Current clinical methods for assessment of flap viability following mastectomy are largely subjective and lack objective data to guide intraoperative decisions. Intraoperative laser-assisted indocyanine green angiography (LA-ICGA) was performed on 20 skin sparing mastectomy flaps. LA-ICGA data were retrospectively compared with clinical outcome. Preoperative, intraoperative, and postoperative digital photographs along with clinical course were evaluated in an effort to identify potential complications. LA-ICGA was performed on 20 breasts in 12 patients. Eleven breasts (55%) demonstrated no wound-healing issues. Nine breasts (45%) experienced wound-healing issues, which were stratified as follows: 1 (5%) mild, 1 (5%) moderate, and 7 (35%) severe. Of these seven severe wound-healing issues, 5 (25%) required debridement and 2 (10%) required complete removal of the prosthetic device. Retrospective analysis demonstrated a 95% correlation between intraoperative imaging and clinical course with 100% sensitivity and 91% specificity. There was a false-positive rate of 9%. This series suggests LA-ICGA is a useful adjunct to determine mastectomy flap viability. Further quantitative advances in this technology may provide objective numerical thresholds to guide intraoperative mastectomy flap debridement when indicated.
Department of Plastic Surgery, Cleveland Clinic Florida, Weston, Florida 33331, USA. newmanm@ccf.org
Martin I
MI
Newman
Michel C
MC
Samson
Joseph F
JF
Tamburrino
Kimberley A
KA
Swartz
D000792:Angiography / Q000379:methods*; D001940:Breast / Q000098:blood supply* / Q000601:surgery*; D004396:Coloring Agents; D003646:Debridement; D062109:Dermatologic Surgical Procedures; D005260:Female; D006801:Humans; D007208:Indocyanine Green; D007430:Intraoperative Care / Q000379:methods*; D007511:Ischemia / Q000517:prevention & control; D007834:Lasers; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy; D011183:Postoperative Complications / Q000517:prevention & control; D012307:Risk Factors; D012867:Skin / Q000098:blood supply; D013524:Surgical Flaps / Q000098:blood supply*; D014945:Wound Healing
D004396:Coloring Agents; D007208:Indocyanine Green