by Varela, Ramon; Casado-Sanchez, Cesar; Zarbakhsh, Shirin;
Diez, Jesus; Hernandez-Godoy, Juan; Landin, Luis
Plastic and
Reconstructive Surgery: January 2020
- Volume 145 - Issue 1 - p 1-10
Background:
Breast reconstruction with the deep inferior epigastric perforator (DIEP) flap
can be associated with complications such as fat necrosis. The authors’
objective was to assess the safety and efficacy of fluorescent angiography with
indocyanine green to reduce fat necrosis. Methods: The authors designed a
parallel, randomized, controlled clinical trial for unilateral breast
reconstruction. The poorly vascularized tissues of the DIEP flap were removed
based on a clinical evaluation in group 1 and based on angiographic criteria in
group 2. The authors recorded the flap dimensions, perfusion in terms of
fluorescence intensity, complications, reoperations, and BREAST-Q questionnaire
scores for both groups. Results: The study included a total of 51 patients. The
flaps showed no size differences after the tissue was excised. The flaps of
group 2 presented higher perfusion rates (p = 0.001). The incidence of fat
necrosis was 59.3 percent in group 1 and 8.3 percent in group 2 (p = 0.001).
Four cases of partial necrosis were recorded in group 1 (18.2 percent) compared
with none in group 2 (0 percent) (p = 0.131). Four patients underwent
reoperation in group 1 (14.8 percent) compared with none in group 2 (0 percent)
(p = 0.113). The patients in group 2 reported higher scores in all domains of
the BREAST-Q. Conclusions: Fluorescent angiography with indocyanine green
significantly reduced the incidence of fat necrosis without diminishing the
flaps’ dimensions. The perfusion rates were significantly higher and the
patients reported significantly greater satisfaction and quality of life.
Fluorescent angiography with indocyanine green may be considered a safe and effective
tool to enhance the outcomes of breast reconstruction with the DIEP flap.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.
