by Hembd, Austin S.; Yan, Jingsheng; Zhu, Hong; Haddock,
Nicholas T.; Teotia, Sumeet S.
Plastic and
Reconstructive Surgery: July 2020 -
Volume 146 - Issue 1 - p 1e-10e
Background:
This study aims to characterize the effect of laser-assisted
indocyanine green fluorescence angiography on fat necrosis and flap failure in
deep inferior epigastric artery perforator (DIEP) flap breast reconstruction.
Methods:
A retrospective
review was performed on 1000 free flaps for breast reconstruction at a single
center from 2010 to 2017. Indocyanine green angiography was used after completion
of recipient-site anastomoses to subjectively assess for areas of
hypoperfusion. A multivariable logistical analysis was conducted with 24
demographic and surgical factors and their effects on fat necrosis and flap
failure.
Results:
Five hundred six DIEP flaps were included in the statistical
analyses. Thirteen percent of flaps had fat necrosis. Indocyanine green
angiography was used for 200 flaps and was independently associated with a
decrease in the odds of fat necrosis (OR, 0.38; p = 0.004). There was no
reduction in flap failure rates when using indocyanine green angiography (OR,
1.15; p = 0.85). However, there was a decrease in flap loss with increasing
venous coupler diameter (OR, 0.031 per 1-mm increase; p = 0.012). The 84.9-g
higher weight of resected tissue before inset without indocyanine green
angiography versus the weight of the tissue resected with indocyanine green
angiography was statistically significant (p = 0.01). Per single incident of
fat necrosis, our cohort underwent an additional 0.69 revision procedures, 1.22
imaging studies, 0.77 biopsies, and 1.7 additional oncologic office visits.
Conclusion:
Intraoperative indocyanine green fluorescence angiography
decreases the odds of fat necrosis, saves volume when flap trimming at inset, and
can significantly reduce the postoperative surveillance burden in DIEP-based
breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
