Application of indocyanine green-based fluorescent angiography in autologous tissue breast reconstruction_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHOU Bo , ZHOU Xiao ,  LI Zan , PENG Xiaowei , YANG Lichang , LÜ Chunliu , SONG Dajiang , WU Peng , PENG Cuie

Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha Hunan, 410013, P.R.China;

Corresponding author：

LI Zan, Email: zzanli@163.com

Keywords：

Indocyanine green; fluorescent angiography; blood infusion of flap; breast reconstruction

DOI：

10.7507/1002-1892.201708048

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

ObjectiveTo investigate the effect of indocyanine green (ICG)-based fluorescent angiography in autologous tissue breast reconstruction.MethodsBetween June 2016 and June 2017, 14 female patients were treated with the autologous tissue breast reconstruction. The age ranged from 27 to 64 years with the median age of 46.5 years. There were 11 patients of one-stage reconstruction, including 9 with invasive ductal carcinoma of breast, 1 with recurrence tumor on chest wall, and 1 with angiosatcoma in the breast. The disease duration ranged from 9 days to 48 months (mean, 6.8 months). There were 3 patients of second-stage breast reconstruction, who underwent mastectomy 3-4 years ago. During operation, the first ICG-based fluorescent angiography was done before cutting off the flap pedicle. According to the results, 13 patients were adjusted the strategy of operation or cut part of flap, only 1 patient kept the original design. Then, the infusion of flaps were confirmed by the second ICG-based fluorescent angiography after transplanted to the recipient site. The area of flap ranged from 24 cm×11 cm to 36 cm×15 cm. All incisions of recipient site were closed by primary suture.ResultsThe fat liquefaction of incision occurred in 1 patient with type 2 diabetes, and the incision healed after debridement operation. The other flaps survived with no flap perfusion related complication. Both donor sites and recipient sites healed by first intention. All patients were followed up 1-14 months (mean, 4 months) with satisfied result of reconstruction. There was no tumor recurrence.ConclusionICG-based fluorescent angiography can reveal the perfusion of the flap in operation instantly and accurately. It should be very helpful to adjusting the strategy in reconstructive operation, especially in the large tissue demanded kinds such as breast reconstruction.

Citation： ZHOU Bo, ZHOU Xiao, LI Zan, PENG Xiaowei, YANG Lichang, LÜ Chunliu, SONG Dajiang, WU Peng, PENG Cuie. Application of indocyanine green-based fluorescent angiography in autologous tissue breast reconstruction. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(4): 491-494. doi: 10.7507/1002-1892.201708048 Copy

1.	Benson RC, Kues HA. Fluorescence properties of indocyanine green as related to angiography. Phys Med Biol, 1978, 23(1): 159-163.
2.	Myers B, Donovan W. An evaluation of eight methods of using fluorescein to predict the viability of skin flaps in the pig. Plast Reconstr Surg, 1985. 75(2): p. 245-50.
3.	Bellamy JL, Mundinger GS, Flores JM, et al. Do adjunctive flap-monitoring technologies impact clinical decision making? An analysis of microsurgeon preferences and behavior by body region. Plast Reconstr Surg, 2015, 135(3): 883-892.
4.	Liu DZ, Mathes DW, Zenn MR, et al. The application of indocyanine green fluorescence angiography in plastic surgery. J reconstr Microsurg, 2011, 27(6): 355-364.
5.	Duggal CS, Madni T, Losken A. An outcome analysis of intraoperative angiography for postmastectomy breast reconstruction. Aesthet Surg J, 2014, 34(1): 61-65.
6.	Wu C, Kim S, Halvorson EG. Laser-assisted indocyanine green angiography: a critical appraisal. Ann Plast Surg, 2013, 70(5): 613-619.
7.	Bigdeli AK, Gazyakan E, Schmidt VJ, et al. Indocyanine green fluorescence for free-flap perfusion imaging revisited: advanced decision making by virtual perfusion reality in visionsense fusion imaging angiography. Surg Innov, 2016, 23(3): 249-260.
8.	Pestana IA, Coan B, Erdmann D, et al. Early experience with fluorescent angiography in free-tissue transfer reconstruction. Plast Reconstr Surg, 2009, 123(4): 1239-1244.
9.	Francisco BS, Kerr-Valentic MA, Agarwal JP. Laser-assisted indocyanine green angiography and DIEP breast reconstruction. Plast Reconstr Surg, 2010, 125(3): 116e-118e.
10.	Munabi NC, Olorunnipa OB, Goltsman D, et al. The ability of intra-operative perfusion mapping with laser-assisted indocyanine green angiography to predict mastectomy flap necrosis in breast reconstruction: a prospective trial. J Plast Reconstr Aesthet Surg, 2014, 67(4): 449-455.
11.	Kanuri A, Liu AS, Guo L. Whom should we SPY? A cost analysis of laser-assisted indocyanine green angiography in prevention of mastectomy skin flap necrosis during prosthesis-based breast reconstruction. Plast Reconstr Surg, 2014. 133(4): 448e-454e.
12.	Chae MP, Hunter-Smith DJ, Rozen WM. Comparative analysis of fluorescent angiography, computed tomographic angiography and magnetic resonance angiography for planning autologous breast reconstruction. Gland Surg, 2015, 4(2): 164-178.
13.	Komorowska-Timek E, Gurtner GC. Intraoperative perfusion mapping with laser-assisted indocyanine green imaging can predict and prevent complications in immediate breast reconstruction. Plast Reconstr Surg, 2010, 125(4): 1065-1073.
14.	Ludolph I, Arkudas A, Schmitz M, et al. Cracking the perfusion code?: Laser-assisted indocyanine green angiography and combined laser Doppler spectrophotometry for intraoperative evaluation of tissue perfusion in autologous breast reconstruction with DIEP or ms-TRAM flaps. J Plast Reconstr Aesthet Surg, 2016, 69(10): 1382-1388.
15.	杨锴, 穆蘭, 刘岩, 等. 吲哚菁绿血管造影在皮瓣手术中的应用价值. 中国修复重建外科杂志, 2015, 29(9): 1113-1116.
16.	胡学庆, 包祺, 姜方震, 等. 吲哚菁绿血管造影在乳腺癌术后乳房重建中的应用. 组织工程与重建外科杂志, 2015, 11(2): 87-89.

1. Benson RC, Kues HA. Fluorescence properties of indocyanine green as related to angiography. Phys Med Biol, 1978, 23(1): 159-163.
2. Myers B, Donovan W. An evaluation of eight methods of using fluorescein to predict the viability of skin flaps in the pig. Plast Reconstr Surg, 1985. 75(2): p. 245-50.
3. Bellamy JL, Mundinger GS, Flores JM, et al. Do adjunctive flap-monitoring technologies impact clinical decision making? An analysis of microsurgeon preferences and behavior by body region. Plast Reconstr Surg, 2015, 135(3): 883-892.
4. Liu DZ, Mathes DW, Zenn MR, et al. The application of indocyanine green fluorescence angiography in plastic surgery. J reconstr Microsurg, 2011, 27(6): 355-364.
5. Duggal CS, Madni T, Losken A. An outcome analysis of intraoperative angiography for postmastectomy breast reconstruction. Aesthet Surg J, 2014, 34(1): 61-65.
6. Wu C, Kim S, Halvorson EG. Laser-assisted indocyanine green angiography: a critical appraisal. Ann Plast Surg, 2013, 70(5): 613-619.
7. Bigdeli AK, Gazyakan E, Schmidt VJ, et al. Indocyanine green fluorescence for free-flap perfusion imaging revisited: advanced decision making by virtual perfusion reality in visionsense fusion imaging angiography. Surg Innov, 2016, 23(3): 249-260.
8. Pestana IA, Coan B, Erdmann D, et al. Early experience with fluorescent angiography in free-tissue transfer reconstruction. Plast Reconstr Surg, 2009, 123(4): 1239-1244.
9. Francisco BS, Kerr-Valentic MA, Agarwal JP. Laser-assisted indocyanine green angiography and DIEP breast reconstruction. Plast Reconstr Surg, 2010, 125(3): 116e-118e.
10. Munabi NC, Olorunnipa OB, Goltsman D, et al. The ability of intra-operative perfusion mapping with laser-assisted indocyanine green angiography to predict mastectomy flap necrosis in breast reconstruction: a prospective trial. J Plast Reconstr Aesthet Surg, 2014, 67(4): 449-455.
11. Kanuri A, Liu AS, Guo L. Whom should we SPY? A cost analysis of laser-assisted indocyanine green angiography in prevention of mastectomy skin flap necrosis during prosthesis-based breast reconstruction. Plast Reconstr Surg, 2014. 133(4): 448e-454e.
12. Chae MP, Hunter-Smith DJ, Rozen WM. Comparative analysis of fluorescent angiography, computed tomographic angiography and magnetic resonance angiography for planning autologous breast reconstruction. Gland Surg, 2015, 4(2): 164-178.
13. Komorowska-Timek E, Gurtner GC. Intraoperative perfusion mapping with laser-assisted indocyanine green imaging can predict and prevent complications in immediate breast reconstruction. Plast Reconstr Surg, 2010, 125(4): 1065-1073.
14. Ludolph I, Arkudas A, Schmitz M, et al. Cracking the perfusion code?: Laser-assisted indocyanine green angiography and combined laser Doppler spectrophotometry for intraoperative evaluation of tissue perfusion in autologous breast reconstruction with DIEP or ms-TRAM flaps. J Plast Reconstr Aesthet Surg, 2016, 69(10): 1382-1388.
15. 杨锴, 穆蘭, 刘岩, 等. 吲哚菁绿血管造影在皮瓣手术中的应用价值. 中国修复重建外科杂志, 2015, 29(9): 1113-1116.
16. 胡学庆, 包祺, 姜方震, 等. 吲哚菁绿血管造影在乳腺癌术后乳房重建中的应用. 组织工程与重建外科杂志, 2015, 11(2): 87-89.

Chinese Journal of Reparative and Reconstructive Surgery

Application of indocyanine green-based fluorescent angiography in autologous tissue breast reconstruction

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content