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Assessment of deep inferior epigastric perforator flap perfusion with near-infrared fluorescence: A pilot study and description of a standardized working protocol.
Michi, Marlies; Verduijn, Pieter S; Corion, Leonard U M; Vahrmeijer, Alexander L; Mulder, Babs G Sibinga.
Affiliation
  • Michi M; Department of Plastic Surgery, Leiden University Medical Center, P.O. Box 9600, Albinusdreef 2, 2333 ZA Leiden, the Netherlands. Electronic address: marliesm90@gmail.com.
  • Verduijn PS; Department of Plastic Surgery, Leiden University Medical Center, P.O. Box 9600, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
  • Corion LUM; Department of Plastic Surgery, Leiden University Medical Center, P.O. Box 9600, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
  • Vahrmeijer AL; Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
  • Mulder BGS; Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
J Plast Reconstr Aesthet Surg ; 75(3): 1171-1178, 2022 03.
Article in En | MEDLINE | ID: mdl-34924327
Fat necrosis (FN) is a common complication after autologous breast reconstruction (ABR) using a free flap, which can influence reconstruction outcome and patient satisfaction. Intraoperative near-infrared fluorescence imaging using indocyanine green (ICG) permits the visualization of flap perfusion. The aim of this study was to assess the effect of near-infrared fluorescence on FN incidence in patients undergoing an ABR with a deep inferior epigastric perforator flap (DIEP) and to propose a standard working protocol for this technique. In this prospective study, patients undergoing one-sided ABR with a DIEP were included. The standard DIEP procedure was complemented with near-infrared fluorescence imaging using the fluorescent tracer ICG to evaluate flap perfusion. This cohort was compared to a retrospective cohort of DIEP procedures without near-infrared fluorescence imaging. Patients and surgery characteristics, as well as postoperative complications, were registered and compared. In both cohorts, 24 patients were included. No significant differences were present between patients and surgery characteristics, including no difference in duration of surgery. In the prospective and retrospective group, the incidence of FN was 4.2% and 33%, respectively (p-value = 0.023). Moreover, microsurgeons were positive about using near-infrared fluorescence as it either provided additional information about perfusion or confirmed the clinical assessment. Our pilot study showed a significant decrease of FN in patients undergoing an ABR with a DIEP when near-infrared fluorescence imaging was used to assess flap perfusion. This study provides a standardized working protocol for near-infrared fluorescence imaging. In the future, large multicenter studies should focus on the quantification of near-infrared fluorescence imaging.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Mammaplasty / Perforator Flap Type of study: Etiology_studies / Guideline / Observational_studies / Risk_factors_studies Limits: Humans Language: En Journal: J Plast Reconstr Aesthet Surg Year: 2022 Document type: Article Country of publication: Netherlands

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Mammaplasty / Perforator Flap Type of study: Etiology_studies / Guideline / Observational_studies / Risk_factors_studies Limits: Humans Language: En Journal: J Plast Reconstr Aesthet Surg Year: 2022 Document type: Article Country of publication: Netherlands