Laser-assisted-indocyanine-green-angiography versus conventional assessment to predict or locate necrotic areas on mastectomy flaps: A prospective clinical trial
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 mas...
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Published in | İstanbul Tıp Fakültesi Dergisi Vol. 82; no. 4; pp. 193 - 198 |
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Main Authors | , |
Format | Journal Article |
Language | English |
Published |
İstanbul Üniversitesi Yayınları
01.10.2019
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Subjects | |
Online Access | Get full text |
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Abstract | 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. |
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AbstractList | 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. |
Abstract_FL | Amaç: Bu çalışmada meme-başı koruyucu mastektomi (MBKM)
fleplerindeki nekrozu yada nekroz lokalizasyonunu, lazer yardımlı
indosiyanin yeşilli angiografinin (LYIYA) tahmin edip edemeyeceğini
konvansiyonel gözlem ile kıyaslayarak saptamaktı.
Yöntem: Meme kanseri nedeniyle 21 hastaya MBKM ve eşzamalı
silikon implant rekonstrüksiyon yapıldı. Ondokuz hastada flep üzerindeki
hipoperfuze alanların lazer absorpsiyon derecesini anlamak
için LYIYA sayıları kullanıldı. Elde edilen sayılar konvansiyonel
gözlem ile kıyaslanarak LYIYA’nın nekroz prediktivitesi saptandı.
Bulgular: Bu 19 mastektomi flebinin 3’ünde (15,8%) parsiyel
cilt nekrozu saptanmış ve LYIYA sayısı ≤7 olarak saptanmıştır.
LYIYA’nın duyarlılığı, özgüllüğü, yalancı pozitifliği ve doğruluğu
sırasıyla 43%, 100%, 57%, ve 79% olarak bulunmuştur. LYIYA ≤7
olan hastalarda daha çok nekroz saptanmış, 60 yaş üstü, sigara
öyküsü, BMI >30 veya intraoperatif tumescent solusyonu kullanılanlarda
LYIYA ≤7 uyumsuz bulunmuş, nekroz tahmininde yanılgıya
sebep olmuştur.
Sonuç: LYIYA sayısı ≤7 bulgusu, mastektomi flep nekrozunu tahmin
edebilmede kullanılabilecek tek anlamlı parametredir. LYIYA
aynı anda nekrozun nerde lokalize olduğunu ve sınırlarını da gösterebilmektedir. |
Author | Balcı,Fatih Levent Uras,Cihan |
AuthorAffiliation | Tıbbi Hizmetler ve Teknikler Bölümü, Anestezi Pr Cerrahi Tıp Bilimleri Bölümü, Genel Cerrahi Anabilim Dalı |
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DocumentTitleAlternate | Mastektomi flebi nekrozunu tahmin ya da lokalize edebilen lazer yardımlı indosiyanin yeşili anjiografinin konvansiyonel yontemle kıyaslanması: Prospektif klinik calışma |
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Keywords | intraoperative angiography meme başı koruyucu mastektomi nipple-sparing mastectomy lazer yardımlı indosiyanin yeşilli angiografi breast Cancer meme kanseri SPY |
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assisted-indocyanine-green-angiography (LA-ICGA) could accurately
predict flap necrosis in... |
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Title | Laser-assisted-indocyanine-green-angiography versus conventional assessment to predict or locate necrotic areas on mastectomy flaps: A prospective clinical trial |
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