title: An investigation of the application of laser-assisted indocyanine green fluorescent dye angiography in pedicle transverse rectus abdominus myocutaneous breast reconstruction.
abstract: BACKGROUND
  Pedicle transverse rectus abdominus myocutaneous (pTRAM) flaps remain the most common method of autologous tissue breast reconstruction. Using pTRAM flaps, complications often arise postoperatively, secondary to inadequate circulation. Tissues from distant angiosomes are associated with poorer perfusion, but this differs among patients. Many modalities have been used to reduce the risk of complications, but none have achieved widespread application. The authors believe that laser-assisted indocyanine green fluorescent dye angiography (LA-ICGA) can potentially reduce the risk of complications.
  
  
  METHODS
  In two routine, single-pedicle, ipsilateral pTRAM flaps, LA-ICGA imaging was performed following the division of the distal rectus muscle and deep inferior epigastric pedicle. The resulting images were used to guide design of the flap and debridement.
  
  
  RESULTS
  In case 1, good perfusion was observed in zone 1 and part of zone 2. In case 2, good perfusion was observed in zone 1 and 50% of zone 3, with little perfusion in zone 2. In both cases, tissues with poor perfusion were debrided before transfer and inset. In both patients, there were no issues with wound healing, tissue necrosis or fat necrosis.
  
  
  CONCLUSIONS
  The variability of perfusion of the pTRAM flap among individuals is well appreciated. LA-ICGA helped to determine the limits of good perfusion and, therefore, the limits of tissue to be preserved for transfer and inset. This helped to avoid harvesting poorly perfused tissue that would have almost certainly experienced necrosis and, ultimately, would have reduced the risk of postoperative complications.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Cleveland Clinic Florida, Weston, Florida, USA.
authors.forename: Martin I
authors.initials: MI
authors.lastname: Newman
authors.forename: Michel C
authors.initials: MC
authors.lastname: Samson
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Tamburrino
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Swartz
authors.forename: Louis
authors.initials: L
authors.lastname: Brunworth