Plastic Surgery Research Council
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TISSUE EXPANDER BREAST RECONSTRUCTIONS EXPERIENCE FEWER COMPLICATIONS WHEN SKIN FLAPS ARE ASSESSED WITH LASER FLUORESCENT ANGIOGRAPHY RATHER THAN CLINICAL JUDGEMENT ALONE
Presenter: Patrick Garvey, MD
Co-Authors: Selber JC; Hobaugh CW; Zhang H; Baumann DP; Butler CE
UT MD Anderson Cancer Ctr.

Background: Vascular compromise of mastectomy skin flaps following skin-sparing mastectomy (SSM) results in adverse outcomes for tissue expander and acellular dermal matrix (TE-ADM) breast reconstruction. Intra-operative laser fluorescent angiography (LFA) has been shown to accurately predict mastectomy skin flap necrosis. However, it's unknown whether it improves clinical outcomes vs. clinical assessment alone. We hypothesized that LFA evaluation of skin flap perfusion in TE-ADM breast reconstructions would result in fewer overall complications and less skin flap necrosis than clinical assessment alone.

Methods: We reviewed all consecutive immediate SSM/TE-ADM breast reconstructions at a single center over 5 years. We compared the outcomes of reconstructions for which LFA was used for skin flap assessment with those for which clinical judgment alone was used prior to the availability of LFA. Primary outcome measures included mastectomy skin flap necrosis (partial or full-thickness) and overall complications. Univariate and multivariate regression analysis controlled for differences between the two groups and analyzed the relationship between patient and reconstruction characteristics and overall complications and necrosis.

Results: A total of 152 patients underwent 207 TE ADM breast reconstructions (92 with LFA and 115 without LFA). Patient characteristics were similar between the two groups. LFA reconstructions had a significantly lower incidence of overall complications (30.4% vs. 47.8%; p=0.01) and mastectomy skin flap necrosis (17.4% vs. 29.6%; p=0.01) than the no-LFA reconstructions. Multivariate regression analysis demonstrated LFA to be protective and associated with an almost 3-fold reduction in the likelihood of developing both skin flap necrosis (OR=0.36, p=0.02) and a postoperative complication (OR=0.36, p=0.005.)

Conclusions: We believe that the additional information provided by LFA positively affected surgeons intraoperative decisions, resulting in improved clinical outcomes. This is the largest study evaluating the effect of LFA use on surgical outcomes of TE-ADM breast reconstructions.


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