Indocyanine green angiography guidance for vascular preservation in skin and nipple sparing mastectomy

Abstract

The skin and/or nipple-sparing approach has become an oncologically sound and desirable choice for women choosing mastectomy. Indocyanine green (ICG) perfusion imaging has been shown to reduce ischemic complications in mastectomy skin aps. Immediate reconstruction requires a well-vascularized skin ap capable of tolerating full expansion.Identi cation of the perforating subcutaneous vessels to the skin envelope may allow for better and more consistent blood vessel preservation and ap perfusion. MethodsThe authors conducted an institutional review board-approved prospective study with 41 patients to assess the feasibility of using ICG perfusion imaging to visualize, cutaneously map, and preserve the vessels that supply the skin ap and nippleareolar complex. For each patient, the number of vessels initially mapped, the number of vessels preserved, the extent to which each vessel was preserved, and the proportion of the ap with adequate perfusion (as de ned by the SPY-Q > 20% threshold) were recorded and analyzed. ResultsVessels were able to be identi ed and marked in a high majority of patients (90%). There was a moderate linear relationship between the number of vessels marked and the number preserved. Successful mapping of vessels was associated with lower rates of wound breakdown (p = 0.036). Mapping and preserving at least one vessel led to excellent ap perfusion (> 90%). No increase in complications was observed from utilizing ICG angiography preoperatively. ConclusionThis prospective study using preoperative ICG perfusion mapping demonstrated safety, feasibility, and good prognostic outcomes.