Laser-assisted-indocyanine-green-angiography versus conventional assessment to predict or locate necrotic areas on mastectomy flaps: A prospective clinical trial

• Published in: İstanbul Tıp Fakültesi Dergisi Vol. 82; no. 4; pp. 193 - 198
• Main Authors: Balcı,Fatih Levent, Uras,Cihan
• Format: Journal Article
• Language: English
• Published: İstanbul Üniversitesi Yayınları 01.10.2019
• Subjects: Tıp; İstanbul; Türkiye; intraoperative angiography; meme başı koruyucu mastektomi; nipple-sparing mastectomy; lazer yardımlı indosiyanin yeşilli angiografi; breast Cancer; meme kanseri; SPY
• DOI: 10.26650/IUITFD.2019.0040
• ISSN: 1305-6441

Objective: The aim of this study was to determine whether laser- assisted-indocyanine-green-angiography (LA-ICGA) could accurately predict flap necrosis in comparison to conventional clinical assessment and visually identify its location during immediate reconstruction following a nipple-sparing mastectomy (NSM). Methods: Twenty-one patients with breast cancer were prospectively enrolled to undergo NSM with immediate implant reconstruction. In 19 cases LA-ICGA numbers were used to show the level of laser absorption of hypo-perfused areas on the mastectomy flaps. Those numbers were compared to conventional assessment to assess the predictive value of LA-ICGA. Results: Of the 19 mastectomy flaps, 3 (15.8%) examples of partial skin flap necrosis with an LA-ICGA value of ≤7 was observed. The sensitivity, specificity, false-positive rate, and accuracy of LA-ICGA were 43%, 100%, 57%, and 79%, respectively. Patients with an LA-ICGA value of ≤7 were found more likely to develop mastectomy flap necrosis, whereas patients aged >60 or, a history of smoking, a BMI >30, or intraoperative use of tumescence solution containing epinephrine were more likely to have an LA-ICGA score ≤7 which is not clinically reliable in predicting necrosis. Conclusion: Our results indicate that a low LA-ICGA score ≤7 is the only significant factor in predicting mastectomy flap necrosis. LA-ICGA could accurately show the location of necrosis.