Intraoperative Assessment of the Relationship Between Nipple Circulation and Incision Site in Nipple-Sparing Mastectomy With Implant Breast Reconstruction Using the SPY Imaging System

Wang, Chi-Yu; Wang, Chin-Hsin; Tzeng, Yuan‐Sheng; Lin, Chin-Ta; Chou, Chang-Yi; Chiang, I-Han; Wu, Chang-Chieh; Chen, Shyi-Gen

doi:10.1097/sap.0000000000001296

Cited by 9 publications

(13 citation statements)

References 8 publications

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“…31,33,37,41,60 Total duration of ICGA from start of recording to the end is reported in 14 studies and is predominantly ranging between 60 and 120 seconds. 27,29,30,33,39,41,47,50,54,62 Assessments of up to 200 31,58 and 300 seconds 36,71 have been reported as well.…”

Section: Systematic Reviewmentioning

confidence: 77%

“…Forty-nine articles, including 1996 surgical flaps, were selected for the review. Study designs included prospective cohort studies (n = 27), 31,34,35,38,39,[41][42][43][47][48][49][50]56,[58][59][60][62][63][64][65][66][67][68][69][70][71] retrospective cohort studies (n = 16), [25][26][27]29,32,33,36,40,44,45,51,55,57,61,72 prospective pilot studies (n = 3), 28,37,52 and retrospective case series (n = 3). 46,53,54 No randomized controlled trials have been performed yet that concern ICGA in plastic and reconstructive flap surgery.…”

Section: Systematic Reviewmentioning

confidence: 99%

“…Several ICGA systems have been described in the literature. In the majority of included studies (n = 29), 24,[26][27][28][30][31][32][38][39][40][41][43][44][45][46][47]51,[53][54][55][56][57][58][59][60][61][62]72,73 the SPY imaging system (Novadaq Technologies, Inc, Toronto, Canada) was used for tissue perfusion assessment; the remainder used the IC-View System (Pulsion Medical Systems, Munich, Germany; n = 8), [63][64][65][66][67][68][69][70] the Photo Dynamic Eye (Hamamatsu Photonics KK, Hamamatsu, Japan; n = 7), 29,33,35,36,48,50,52 the Visionsense 3D highdefinition near-infrared-guided indocyanine green video angiography system (ICG-NIR-VA, Orangeburg, NY; n = 1), 42 Hyper Eye Medical System (Mizuho Medical Co, Ltd, Tokyo, Japan; n = 1), 34 the Fluobeam device (Fl...…”

Section: Systematic Reviewmentioning

confidence: 99%

“…The majority (n = 37) of included articles reported a clear dosing regimen for ICGA, ranging from 2.5 to 25 mg or 0.025 to 0.5 mg/kg when a fixed dose (n = 21) 27,30,33,38,39,[44][45][46][47][48]50,[52][53][54]56,[58][59][60]62,72,73 or weight-adjusted dose (n = 16) 25,28,[34][35][36][37]42,[63][64][65][66][67][68][69]71,74 was applied, respectively. Nine studies did not report any ICG dosing.…”

Section: Systematic Reviewmentioning

confidence: 99%

“…In addition, 9 articles report a flush of saline following ICG injection. 25,27,35,47,55,56,59,72,75 Working Distance. The working distance, defined as the distance between the imaging head of the ICGA system and the area of interest (ie, skin of the flap), is reported in only 11 articles.…”

Section: Systematic Reviewmentioning

confidence: 99%

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Optimizing Indocyanine Green Fluorescence Angiography in Reconstructive Flap Surgery: A Systematic Review and Ex Vivo Experiments

et al. 2019

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Background. Indocyanine green angiography (ICGA) offers the potential to provide objective data for evaluating tissue perfusion of flaps and reduce the incidence of postoperative necrosis. Consensus on ICGA protocols and information on factors that have an influence on fluorescence intensity is lacking. The aim of this article is to provide a comprehensive insight of in vivo and ex vivo evaluation of factors influencing the fluorescence intensity when using ICGA during reconstructive flap surgery. Methods. A systematic literature search was conducted to provide a comprehensive overview of currently used ICGA protocols in reconstructive flap surgery. Additionally, ex vivo experiments were performed to further investigate the practical influence of potentially relevant factors. Results. Factors that are considered important in ICGA protocols, as well as factors that might influence fluorescence intensity are scarcely reported. The ex vivo experiments demonstrated that fluorescence intensity was significantly related to dose, working distance, angle, penetration depth, and ambient light. Conclusions. This study identified factors that significantly influence the fluorescence intensity of ICGA. Applying a weight-adjusted ICG dose seems preferable over a fixed dose, recommended working distances are advocated, and the imaging head during ICGA should be positioned in an angle of 60° to 90° without significantly influencing the fluorescence intensity. All of these factors should be considered and reported when using ICGA for tissue perfusion assessment during reconstructive flap surgery.

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Section: Systematic Reviewmentioning

confidence: 77%

Section: Systematic Reviewmentioning

confidence: 99%

Section: Systematic Reviewmentioning

confidence: 99%

Section: Systematic Reviewmentioning

confidence: 99%

Section: Systematic Reviewmentioning

confidence: 99%

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Optimizing Indocyanine Green Fluorescence Angiography in Reconstructive Flap Surgery: A Systematic Review and Ex Vivo Experiments

et al. 2019

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Utility of Indocyanine Green Angiography to Identify Clinical Factors Associated With Perfusion of Paramedian Forehead Flaps During Nasal Reconstruction Surgery

Abdelwahab

Kandathil

Most

et al. 2019

JAMA Facial Plast Surg

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Identifying factors affecting forehead flap neovascularization during nasal reconstruction surgical procedures using quantitative dynamics of fluorescence from indocyanine green angiography may be associated with reduced vascular complications.OBJECTIVES To identify quantifiable forehead flap perfusion measures using indocyanine green angiography during nasal reconstruction procedures and to evaluate clinical factors associated with neovascularization. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study of 71 patients at a tertiary referral center of Stanford University, Stanford, California, between January 1, 2010, and March 31, 2018, undergoing forehead flap nasal reconstruction surgery with flap perfusion assessed by indocyanine green angiography.EXPOSURES Indocyanine green angiography was performed intraoperatively to record forehead flap neovascularization during the second stage of nasal reconstruction surgery after temporary clamping of the pedicle. MAIN OUTCOMES AND MEASURESWith use of quantifiable data of fluorescence dynamics, flap perfusion in association with a reference point in the cheek after pedicle clamping was assessed by 2 methods: (1) ingress (arterial inflow) and egress (venous outflow) flap-to-cheek ratio and (2) flap-to-cheek perfusion (fluorescence) ratio at 3 time points (midpoint of indocyanine green flap inflow, maximum fluorescence [peak], and midpoint of indocyanine green flap outflow) and their calculated mean. Association of the perfusion measures with patient and procedural factors was performed using linear regression models. RESULTSOf the 71 patients included in the study, 43 (61%) were men; the mean (SD) age was 71.1 (11.0) years. The mean (SD) flap-to-cheek inflow ratio was 0.48 (0.40), peak fluorescence ratio was 0.59 (0.34), and outflow ratio was 0.88 (0.42). The calculated mean (SD) flap-to-cheek perfusion ratio of these measures was 0.65 (0.35). The mean (SD) flap-to-cheek ingress ratio was 0.54 (0.36) and egress ratio was 0.65 (0.98). With use of a multivariable regression model, the time between stages was positively associated with flap-to-cheek ingress ratio (β, 0.015; 95% CI, 0.001 to 0.030), and cartilage grafting was negatively associated with flap-to-cheek outflow ratio (β, -0.240; 95% CI, -0.472 to -0.008). CONCLUSIONS AND RELEVANCEThe findings suggest that indocyanine green angiography is an effective method to quantify relative neovascularization perfusion of forehead flaps. Future applications may include the use of this technology to aid in early flap division and ensure adequate perfusion among high-risk patients.LEVEL OF EVIDENCE NA.

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Neovascularization Perfusion of Melolabial Flaps Using Intraoperative Indocyanine Green Angiography

Abdelwahab

Spataro

Kandathil

et al. 2019

JAMA Facial Plast Surg

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IMPORTANCE Assessment of melolabial flap perfusion using indocyanine green (ICG) angiography for nasal reconstruction has not been previously described.OBJECTIVE To assess melolabial flap relative perfusion using ICG angiography in nasal reconstruction and highlight its clinical relevance. DESIGN, SETTING, AND PARTICIPANTSIn this retrospective case series at a tertiary referral center, 10 patients undergoing melolabial flap reconstruction of nasal defects between January 2015 to April 2018 with flap perfusion were assessed by ICG angiography. EXPOSURES Indocyanine green angiography was performed to assess melolabial flap perfusion at second stage surgery after temporary clamping of the pedicle and after pedicle division and flap inset. MAIN OUTCOMES AND MEASURESFlap perfusion in relation to a reference point on the cheek was calculated after both pedicle clamping and division by 2 methods: (1) ingress (arterial inflow) and egress (venous outflow) flap-to-cheek ratio; (2) flap-to-cheek perfusion (fluorescence) ratio at 3 time points (midpoint of ICG flap inflow, maximum [peak] fluorescence, and midpoint of ICG outflow), and their calculated mean. Correlations of perfusion with time between stages, and patient factors were performed; perfusion parameters after temporary pedicle clamping and after division and flap inset were compared.RESULTS Ten patients (mean [SD] age, 66 [7.5] years) were enrolled with a mean (SD) interval of 23 (4) days between first and second surgery. No correlation existed between perfusion parameters and time interval between first and second stage, or any other patient factors. Of the different perfusion parameters, a statistically significant difference was observed when comparing temporary clamping and postdivision mean (SD) flap-to-cheek perfusion ratio (0.89 [0.22] and 0.80 [0.19]; 95% CI, 4.1-12.6; P = .001), as well as mean (SD) peak perfusion ratio (0.81 [0.2] and 0.77 [0.2]; 95% CI, 0.005-0.080; P = .02) only. No partial or complete flap necrosis was reported after pedicle division.CONCLUSIONS AND RELEVANCE Indocyanine green angiography is an effective method to determine neovascularization perfusion of melolabial flaps, with a mean perfusion of 89% after pedicle clamping. Future applications of this technology include use in patients at high risk for flap necrosis, or those who may benefit from early flap division to ensure adequate perfusion and minimize the time interval between staged procedures.LEVEL OF EVIDENCE NA.

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Intraoperative Assessment of the Relationship Between Nipple Circulation and Incision Site in Nipple-Sparing Mastectomy With Implant Breast Reconstruction Using the SPY Imaging System

Cited by 9 publications

References 8 publications

Optimizing Indocyanine Green Fluorescence Angiography in Reconstructive Flap Surgery: A Systematic Review and Ex Vivo Experiments

Optimizing Indocyanine Green Fluorescence Angiography in Reconstructive Flap Surgery: A Systematic Review and Ex Vivo Experiments

Utility of Indocyanine Green Angiography to Identify Clinical Factors Associated With Perfusion of Paramedian Forehead Flaps During Nasal Reconstruction Surgery

Neovascularization Perfusion of Melolabial Flaps Using Intraoperative Indocyanine Green Angiography

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