How should indocyanine green dye angiography be assessed to best predict mastectomy skin flap necrosis? A systematic review

Driessen, Caroline; Arnardottir, Tinna Harper; Lorenzo, Andres Rodriguez; Mani, Maria

doi:10.1016/j.bjps.2020.02.025

Cited by 37 publications

(34 citation statements)

References 28 publications

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“…Moyer et al reported ICG-A to have a positive predictive value of 88% and a negative predictive value of 16% for mastectomy flap necrosis with a cutoff value at 33% 54 . In addition, a paper published in 2020 proposed an algorithm for mastectomy skin flap ischemia 55 , but no international consensus regarding cutoff values have been published to the authors knowledge [56][57][58] .…”

Section: Discussionmentioning

confidence: 99%

Use of Indocyanine Green Angiography decreases the risk of complications in autologous- and implant-based breast reconstruction: A systematic review and meta-analysis

Lauritzen

Damsgaard

2021

Journal of Plastic, Reconstructive & Aesthetic Surgery

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Introduction: Indocyanine Green Angiography (ICG-A) is an imaging technique used to visualize tissue perfusion in real time. The aim of this systematic review and meta-analysis is to evaluate all published papers on breast reconstruction using ICG-A, which provides information on complication rates and to investigate whether the use of this peroperative method decreases the risk of complications. Materials and Methods: MEDLINE/PubMed, EMBASE, Cochrane, and UpToDate were searched using relevant terms. The literature was assessed using the PRISMA guidelines. Inclusion criteria were: original articles written in English assessing ICG-angiography in breast reconstruction. The individual studies were evaluated according to Cochrane guidelines. Results: The search yielded 243 papers on ICG-A and breast reconstruction. Twenty-six of these were included for analysis. The risk of overall major complications ([OR] = 0.53, 95% confidence interval (CI) = 0.43-0.66, p = 0.00001) and overall loss of reconstruction ([OR] = 0.58, 95% CI = 0.37-0.92, and p = 0.020) was significantly lower when peroperative ICG-A was used. When using ICG-A to evaluate mastectomy flaps, a statistically lower risk of major complications ([OR] = 0.56 and p = 0.0001) and the loss of reconstruction was found ([OR] = 0.46, p = 0.006).

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Section: Discussionmentioning

confidence: 99%

Use of Indocyanine Green Angiography decreases the risk of complications in autologous- and implant-based breast reconstruction: A systematic review and meta-analysis

Lauritzen

Damsgaard

2021

Journal of Plastic, Reconstructive & Aesthetic Surgery

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“…Of course, high radiation dose is the most important drawback of this method. IGA, which is frequently used to evaluate the viability of mastectomy skin flaps, has recently been applied for assessment of skin flaps prior to their transfer 37,38 . IGA helps identify the viable portion of the flap and the location of the nutrient vessels.…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of Achilles region defects: a single-center experience

Eser¹,

Ceylan²,

Gencel³

et al. 2021

Preprint

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Background: Reconstruction of Achilles tendon and the overlying tissue defects is a challenging undertaking. The spectrum of available repair methods range from secondary healing to use of free flaps. Method: In this study, we retrospectively evaluated 14 patients who underwent reconstruction of Achilles region defect between 2016 and 2019 at a single center. Results: Reconstructions were performed with secondary healing (n=2), negative pressure wound therapy and skin grafting (n=2), free flaps (n=6), and local and distant flaps (n=4). Satisfactory aesthetic and functional outcomes were achieved in all patients. One patient developed partial skin graft loss. Marginal necrosis occurred in one of the local flaps. Wound dehiscence and flap retraction occurred in one of the free (superficial circumflex iliac artery perforator) flaps. One patient undergoing reconstruction with ulnar artery perforator flap developed intraoperative atrial fibrillation; the operation was terminated and reconstruction completed with skin grafting. Conclusion: Orthoplastic reconstruction should be kept in mind for Achilles tendon defects. Use of special digital imaging techniques facilitates flap surgery and helps minimize the risk of flap complications. Conventional approaches are suitable for shallow small skin lesions. Local flaps are good options for deeper skin defects owing to superior aesthetic outcomes. Superthin free flaps offer a distinct advantage in skillful hands. Use of multi-content free chimeric flaps for reconstruction of complex defects facilitates better anatomical repair. Cross leg or flow-through flaps may be considered in patients with compromised distal circulation. Selection of the most reliable approach for Achilles reconstruction is a key imperative to achieve favorable outcomes.

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“…The absolute values of fluorescence considered to be predictive for necrosis vary greatly among studies. These values can be influenced by measurement tools and surrounding circumstances, such as ambient lighting in the operation theater (26). There are generalization issues for fluorescence intensity because intensities obtained by various fluorescence imaging systems have different values and cannot be compared with each other without additional correlation study (23).…”

Section: Discussionmentioning

confidence: 99%

Pure hemi-periareolar incision versus conventional lateral radial incision mastectomy and direct-to-implant breast reconstructions: comparison of indocyanine green angiographic perfusion and necrosis of the nipple

et al. 2020

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Background: This study evaluated the feasibility of direct-to-implant breast reconstruction after nipplesparing mastectomy using pure hemi-periareolar incision without extension and with the aid of indocyanine green angiographic evaluation on the mastectomy skin flap.Methods: Patients who underwent immediate direct-to-implant breast reconstruction from December 2018 to February 2020 were included. After nipple-sparing mastectomy, indocyanine green angiographic evaluation of perfusion to nipple-areola complex was performed by video recording with a near infrared camera, and nipple perfusion time and perfusion pattern were analyzed. Patients were divided into a pure hemi-periareolar incision group and conventional lateral radial incision groups to compare nipple perfusion and surgical outcomes.Results: A total of 61 breasts in 56 patients were included. Pure hemi-periareolar incision was used in 41 breasts, and conventional lateral radial incisions were used in 20 breasts. Nipple perfusion time was significantly increased in the pure hemi-periareolar incision group (79.6±65.8 vs. 43.2±49.8 seconds, P=0.031). While minor nipple-areola complex necrosis was significantly increased in the pure hemiperiareolar incision group (19.5% versus 0%; P=0.044), major nipple-areola complex necrosis (2.4% versus 5.0%; P>0.999) was not significantly different between the two groups. The rates of nipple-areola complex necrosis were 0%, 16.7%, and 63.6% in rapid, delayed, and no perfusion groups, respectively (P<0.001). No nipple perfusion pattern was a significant predictor for nipple-areola complex necrosis in univariable and multivariable analyses (P<0.001). There was no case of reconstruction failure.Conclusions: Immediate direct-to-implant breast reconstruction after nipple-sparing mastectomy using pure hemi-periareolar incision can be safely performed using indocyanine green angiographic evaluation on the mastectomy skin flap.

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How should indocyanine green dye angiography be assessed to best predict mastectomy skin flap necrosis? A systematic review

Cited by 37 publications

References 28 publications

Use of Indocyanine Green Angiography decreases the risk of complications in autologous- and implant-based breast reconstruction: A systematic review and meta-analysis

Use of Indocyanine Green Angiography decreases the risk of complications in autologous- and implant-based breast reconstruction: A systematic review and meta-analysis

Reconstruction of Achilles region defects: a single-center experience

Pure hemi-periareolar incision versus conventional lateral radial incision mastectomy and direct-to-implant breast reconstructions: comparison of indocyanine green angiographic perfusion and necrosis of the nipple

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