In Vivo Perforasome Perfusion in Hemi-DIEP Flaps Evaluated with Indocyanine-green Fluorescence Angiography and Infrared Thermography

Chaudhry, Muiz Akram; Mercer, James B.; Weerd, Louis de

doi:10.1097/gox.0000000000003560

Cited by 8 publications

(4 citation statements)

References 37 publications

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“…Preoperatively, it is one of the key points to accurately determine the perforator location. It can be preoperatively assessed by multiple technologies, such as HHD, CTA, MRA (Ono et al, 2020) and near‐infrared fluorescence imaging systems (Chaudhry et al, 2021). Different methods have their own unique advantages and indications; however, HHD was determined to be the most commonly used means for perforator identification in this meta‐analysis.…”

Section: Discussionmentioning

confidence: 99%

Analysis of risk factors for complications of perforator propeller flaps used for soft tissue reconstruction after malignant tumor resection: A systematic review and meta‐analysis

Yue

Ju²,

2022

Microsurgery

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Background: Perforator propeller flaps (PPFs) have been widely used due to their numerous advantages; however, they were also associated with various complications. Herein, we analyzed the risk factors for complications of PPFs used for soft tissue reconstruction after malignant tumor resection. Methods:We searched databases for articles on soft tissue reconstruction using PPFs after malignant tumor resection published between January 1991 and April 2021. Studies were selected according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. Fixed effects models and relative risks were used for data analysis. Funnel plots and Begg's test were used to evaluate publication bias.Results: Twenty-six articles met the inclusion criteria. Complications were found in 24.7% of all patients. The four significant risk factors were age equal or older than 60 years (pooled relative risk, 1.83; p = .04), smoking (pooled relative risk, 2.32; p = .03), diabetes (pooled relative risk, 2.59; p = .01) and radiotherapy (pooled relative risk, 2.09; p = .01). Hypertension, defects located in the extremities, flap size equal or greater than 100 cm 2 , and pedicle rotation equal or greater than 120 degrees were not significant risk factors for complications. No publication bias was found in the included articles. Conclusion:Age equal or older than 60 years, smoking, diabetes and radiotherapy are four risk factors for complications when PPFs are used to reconstruct soft tissue defects resulting from malignant tumor resection.

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Section: Discussionmentioning

confidence: 99%

Analysis of risk factors for complications of perforator propeller flaps used for soft tissue reconstruction after malignant tumor resection: A systematic review and meta‐analysis

Yue

Ju²,

2022

Microsurgery

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“…ICG-A is more commonly used as an intraoperative method for tissue perfusion and anastomotic patency. ICG-A was also compared to infrared thermography (IRT) with comparable results (Chaudhry et al, 2021;Mercer et al, 2018).…”

Section: Discussionmentioning

confidence: 85%

“…ICG‐A is more commonly used as an intraoperative method for tissue perfusion and anastomotic patency. ICG‐A was also compared to infrared thermography (IRT) with comparable results (Chaudhry et al, 2021; Mercer et al, 2018). Further validation studies of these methods are needed to characterize their indications and limitations.…”

Section: Discussionmentioning

confidence: 94%

Flap perfusion assessment with indocyanine green angiography in deep inferior epigastric perforator flap breast reconstruction: A systematic review and meta‐analysis

et al. 2023

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BackgroundIndocyanine green angiography (ICG‐A) has been widely applied for intraoperative flap assessment in DIEP flap breast reconstruction. However, the beneficial effect of ICG‐A in DIEP flap breast reconstruction is still uncertain and no standardized protocol is available. This study aims to analyze the clinical outcome and comprehensively review protocols of this field.MethodsA systematic review was conducted in MEDLINE, EMBASE, and Cochrane CENTRAL databases until September 15, 2022. Studies on the utility of intraoperative ICG‐A in DIEP breast reconstruction were included. Data reporting reconstruction outcomes were extracted for pooled analysis.ResultsA total of 22 studies were enrolled in the review, among five studies with 1021 patients included in the meta‐analysis. The protocols of ICG‐A assessment of DIEP flap varied among studies. According to the pooled results, the incidence of postoperative fat necrosis was 10.89% (50 of 459 patients) with ICG‐A and 21.53% (121 of 562 patients) with clinical judgment. The risk for postoperative fat necrosis was significantly lower in patients with intraoperative ICG‐A than without (RR 0.47 95% CI 0.29–0.78, p = .004, I2 = 51%). Reoperation occurred in 5 of 48 patients (10.42%) in the ICG‐A group and in 21 of 64 patients (32.82%) in the control group summarized from reports in two studies. The risk for reoperation was lower in the ICG‐A group than in the control group (RR 0.41 95% CI 0.18–0.93, p = .03, I2 = 0%). Other complications, including flap loss, seroma, hematoma, dehiscence, mastectomy skin necrosis, and infection, were comparable between the two groups. Heterogeneities among studies were acceptable. No significant influence of specific studies was identified in sensitivity analysis.ConclusionsICG‐A is an accurate and reliable way to identify problematic perfusion of DIEP flaps during breast reconstruction. Protocols of ICG‐A differed in current studies. Intraoperative ICG‐A significantly decreases the rate of fat necrosis and reoperation in patients undergoing DIEP breast reconstruction. The synthesized results should be interpreted sensibly due to the sample size limitation. RCTs on the outcomes and high‐quality studies for an optimized ICG‐A protocol are still needed in the future.

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“…In addition, use of ICG fluorescence angiography as an adjunct to aid in real-time visualization of the perfusion of the flaps during the operation and between surgical phases is increasing. A study by Chaudhry et al 42 showed that ICG fluorescence angiography and infrared thermography produce comparable results in the evaluation of perforasome perfusion both before and after perforator dissection.…”

Section: Discussionmentioning

confidence: 99%

The Delay Procedure in Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction

Beugels¹,

Levine²,

Vasile³

et al. 2023

Plastic &Amp; Reconstructive Surgery

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utologous breast reconstruction is the standard of care after mastectomy because of its more natural, permanent results, and high level of patient satisfaction. [1][2][3] The deep inferior epigastric artery perforator (DIEP) flap, using the lower abdominal skin and subcutaneous tissue, is the traditional workhorse for autologous breast reconstruction. 4 Over the years, several techniques have been suggested to address the challenge of insufficient donor tissue for abdominal-based perforator flap breast reconstruction. In addition to the variety of alternative flap options that have been described, stacked or bipedicled abdominal flaps can be used for unilateral breast reconstruction. [5][6][7][8][9][10][11][12][13][14][15][16] For bilateral breast reconstruction, bilateral stacked flaps or four-flap breast reconstructions (eg, a combination of abdominal flaps and other free flaps) can be considered, using two separate donor sites. 17-21 For these cases, the stacked hemiabdominal extended perforator (SHAEP) flap was previously introduced using a single abdominal donor site to limit morbidity. 6 However, these types of Background: The delay procedure in deep inferior epigastric artery perforator (DIEP) flap breast reconstruction, in which the reduced-caliber choke vessels play a major role, can provide more well-perfused tissue than a standard DIEP flap. The aim of this study was to review the authors' experience with this technique, evaluate the indications, and analyze the surgical outcomes. Methods: A retrospective study was conducted of all consecutive DIEP delay procedures performed between March of 2019 and June of 2021. Patient demographic characteristics, operative details, and complications were registered. Patients had preoperative imaging by magnetic resonance angiography to select dominant perforators. The surgical technique involves a two-stage operation. During the first operation, the flaps were pedicled on a dominant perforator and a lateral skin bridge extending toward the lateral flank and lumbar fat; in a second stage, the flap was harvested and transferred. Results: A total of 82 extended DIEP delay procedures were performed to reconstruct 154 breasts. The majority were bilateral breast reconstructions (87.8%). The delay procedure was used for 38 primary reconstructions (46.3%) and 32 tertiary reconstructions (39.0%). The primary indication was the need for additional volume (79.3%), followed by extensive abdominal scarring and liposuction. After the first operation, seroma was the most frequently observed complication (7.3%). After the second operation, three total flap losses (1.9%) were observed. Conclusions: The delay procedure in DIEP flap breast reconstruction results in the harvest of a good amount of abdominal tissue by adding a preliminary procedure. This technique can convert cases previously considered unsuitable into suitable candidates for abdominal-based breast reconstruction. (Plast.

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In Vivo Perforasome Perfusion in Hemi-DIEP Flaps Evaluated with Indocyanine-green Fluorescence Angiography and Infrared Thermography

Cited by 8 publications

References 37 publications

Analysis of risk factors for complications of perforator propeller flaps used for soft tissue reconstruction after malignant tumor resection: A systematic review and meta‐analysis

Analysis of risk factors for complications of perforator propeller flaps used for soft tissue reconstruction after malignant tumor resection: A systematic review and meta‐analysis

Flap perfusion assessment with indocyanine green angiography in deep inferior epigastric perforator flap breast reconstruction: A systematic review and meta‐analysis

The Delay Procedure in Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction

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