Indocyanine green angiography for preventing postoperative mastectomy skin flap necrosis in immediate breast reconstruction

Pruimboom, Tim; Schols, Rutger M.; Kuijk, Sander MJ Van; Hulst, R.R. van der; Qiu, Shan Shan

doi:10.1002/14651858.cd013280

Cited by 5 publications

(6 citation statements)

References 19 publications

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“…How this approach could be applied and validated in the current context is crucial. As reported in the current study [9], a prospective trial and a systematic review failed to demonstrate convincing evidence of its utility in breast [13] and abdominal [16] reconstructive surgery. Clearly, ensuring that flaps are well vascularized at the time of closure may be more predictive than assessing preoperative transcutaneous oxygenation, and what happens to the skin after surgery is much more relevant for the fate of the wound.…”

Section: How Do We Get There?mentioning

confidence: 50%

CORR Insights®: Transcutaneous Oximetry Does Not Reliably Predict Wound-healing Complications in Preoperatively Radiated Soft Tissue Sarcoma

Fabbri

2022

Clin Orthop Relat Res

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The author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writer, and do not reflect the opinion or policy of CORR ® or The Association of Bone and Joint Surgeons ® .

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Section: How Do We Get There?mentioning

confidence: 50%

CORR Insights®: Transcutaneous Oximetry Does Not Reliably Predict Wound-healing Complications in Preoperatively Radiated Soft Tissue Sarcoma

Fabbri

2022

Clin Orthop Relat Res

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“…Previously, a Cochrane review studied the effect of ICG‐A for preventing postoperative mastectomy skin flap necrosis in immediate breast reconstruction (Pruimboom, Schols, et al, 2020). However, conclusion remained elusive as low quality of evidence were presented.…”

Section: Discussionmentioning

confidence: 99%

“…Postoperative benefit of ICG‐A is still to be determined despite a Cochrane review of 1589 patients undergoing autologous and prosthetic breast reconstruction (Pruimboom, Schols, et al, 2020). Recently, studies have seen increasing usage of ICG‐A in DIEP flap breast reconstruction.…”

Section: Introductionmentioning

confidence: 99%

“…Recently, studies have seen increasing usage of ICG‐A in DIEP flap breast reconstruction. Despite the popularity of ICG‐A in DIEP flap surgery, whether clinical outcomes benefit from ICG‐A remains to be discussed (Duggal et al, 2014; Parmeshwar et al, 2021; Pruimboom, Schols, et al, 2020). Moreover, new evidence has been added to this field recently (Hembd et al, 2020; Malagón‐López, Vilà, et al, 2019; Michi et al, 2022; Varela et al, 2020; Yoo et al, 2022).…”

Section: Introductionmentioning

confidence: 99%

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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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“…Given that the current investigation showed no association between preoperative transcutaneous oximetry and wound-healing complications, the question remains: Is there a tool that clinicians can rely upon? The field of plastic surgery has adopted rather regular use of a fluorescent imaging technique utilizing indocyanine green (ICG) [3,14,16,17]. A recent investigation reported the use of ICG fluorescent imaging of the skin perfusion in sarcoma surgery at the time of resection [15].…”

Section: Discussion Of Key Findingsmentioning

confidence: 99%

Transcutaneous Oximetry Does Not Reliably Predict Wound-healing Complications in Preoperatively Radiated Soft Tissue Sarcoma

Nystrom

Mesko

Jin

et al. 2022

Clin Orthop Relat Res

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Background Surgical wound-healing complications after tumor resections in tissue that has been preoperatively radiated are a major clinical problem. Most studies have reported that complications occur in more than 30% of patients undergoing such resections in the lower extremity. There is currently no available method to predict which patients are likely to have a complication. Transcutaneous oximetry has been identified in preliminary studies as potentially useful, but the available evidence on its efficacy for this application thus far is inconclusive. Questions/purposes (1) Does transcutaneous oximetry measurement below 25 mmHg at any location in the surgical wound bed predict a wound-healing complication?(2) Does recovery (increase) in transcutaneous oxygen measurement during the rest period between the end of radiation and the time of surgery protect against woundhealing complications? Methods A prospective, multi-institution study was coordinated to measure skin oxygenation at three timepoints in patients undergoing surgery for a lower extremity soft tissue sarcoma after preoperative radiation. Between 2016 and 2020, the five participating centers treated 476 patients for lower extremity soft tissue sarcoma. Of those, we considered those with a first-time sarcoma treated with radiation before limb salvage surgery as potentially eligible. Based on that, 21% (98 of 476) were eligible; a further 12% (56 of 476) were excluded because they refused to participate or ultimately, they were treated with a flap, amputation, or skin graft. Another 1% (3 of 476) of patients were lost because of incomplete datasets or follow-up less than 6 months, leaving 8% (39 of 476) for analysis here. The mean patient age was 62 6 14 years, 62% (24 of 39) of the group were men, and 18% (7 of 39) of patients smoked cigarettes; 87% (34 of 39) of tumors were intermediate/high grade, and the most common histologic subtype was undifferentiated pleomorphicThe institution of one or more of the authors (LMN, BJM) has received, during the study period, funding from the Orthopaedic Research and Education Foundation (award number 16-054) and funding provided by the Musculoskeletal Tumor Society. Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request.

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Indocyanine green angiography for preventing postoperative mastectomy skin flap necrosis in immediate breast reconstruction

Cited by 5 publications

References 19 publications

CORR Insights®: Transcutaneous Oximetry Does Not Reliably Predict Wound-healing Complications in Preoperatively Radiated Soft Tissue Sarcoma

CORR Insights®: Transcutaneous Oximetry Does Not Reliably Predict Wound-healing Complications in Preoperatively Radiated Soft Tissue Sarcoma

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

Transcutaneous Oximetry Does Not Reliably Predict Wound-healing Complications in Preoperatively Radiated Soft Tissue Sarcoma

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