Intraoperative Laser-Assisted Indocyanine Green Imaging Can Reduce the Rate of Fat Necrosis in Microsurgical Breast Reconstruction
Clifford Sheckter, MD, Arash Momeni, MD.
Stanford, Stanford, CA, USA.
PURPOSE: Fat necrosis following microsurgical breast reconstruction is common and problematic for patients and surgeons alike. Indocyanine green angiography provides a means of evaluating flap perfusion at the time of surgery to inform judicious excision of hypoperfused tissue. We hypothesized that incorporation of protocolized ICG-informed flap debridement at the time of surgery would decrease the incidence of fat necrosis.
METHODS: A single institution cohort study was performed evaluating patients before and after implementation of protocolized ICG-guided flap excision. Variables included demographics, procedural details, and complications. Multivariable analysis was used to determine significant differences between the cohorts and evaluate for meaningful changes in fat necrosis.
RESULTS: 80 patients were included, accounting for 137 flaps. Flap type was the only significant difference between the two groups with the ICG group more likely to be deep inferior epigastric perforator flaps, 43.1% vs. 25.3% p=0.038. The overall postoperative incidence of fat necrosis was 14.6 % (20 of 137 flaps). Comparing by cohort, the standard debridement group showed 18 of 79 flaps with fat necrosis (22.8%), while the ICG-informed debridement group showed only 2 of 58 flaps with fat necrosis (3.4%), odds ratio 0.11 (95% CI 0.02-0.60, p-value=0.011). There were no other significant differences in complication profile.
CONCLUSION: Intraoperative use of indocyanine green angiography was associated with significantly lower odds of fat necrosis. This technology may reduce additional revisionary operations and improve patient satisfaction. Additional studies are needed to determine whether this innovation is cost-effective and generalizable to the entire autologous breast reconstruction population.
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