ObjectiveTo analyze the value of indocyanine green (ICG) fluorescence imaging in the evaluation of blood flown of ipple-areola complex (NAC) and implant selection during single-port endoscopic breast reconstruction. Methods From November 2018 to March 2020, 19 patients who underwent single-port inflatable endoscopic nipple-sparing mastectomy combined with breast reconstruction in Beijing Friendship Hospital were retrospectively collected. ICG fluorescence imaging technology was used to evaluate the blood supply pattern and the risk of ischemic necrosis of NAC, so as to guide the selection of implant. At the same time, 14 patients who underwent single-port inflatable endoscopic nipple-sparing mastectomy combined with breast reconstruction in Beijing Friendship Hospital from February 2017 to October 2018 were selected as the historical control group (control group). NAC ischemic necrosis, breast satisfaction and implant removal were compared between the two groups. Results In the ICG group, there were3 cases of V1 pattern and 2 cases of NAC ischemic necrosis (1 case of grade 1, 1 case of grade 2). There was no NAC ischemic necrosis in 16 patients with V2 mode and V3 mode. No implant loss occurred in any of the patients. In the control group, 5 cases had NAC ischemic necrosis (all were severe ischemic necrosis), and 2 cases had implant loss. The rate of severe NAC ischemic necrosis in the ICG group was lower than that in the control group (P<0.01), but there was no significant difference in implant loss rate between the two groups (P=0.17). The breast satisfaction score of the ICG group was higher than that of the control group (P<0.01), but there were no significant difference in satisfaction scores of chestwell-being, psychological well-being and sexual well-being between the two groups (P>0.05). Conclusions ICG imaging can be used to evaluate the blood supply pattern during the operation of prosthetic body mass reconstruction, guide the choice of implant in immediate breast reconstruction, so as to further improve postoperative breast satisfaction.
ObjectiveTo explore the feasibility of using indocyanine green (ICG) angiography to detect brachial artery perforators, and the clinical application of brachial artery perforator propeller (BAPP) flaps to repair soft tissue defects of the trunk and upper limbs.MethodsBetween August 2016 and February 2019, ICG angiography was used to detect the perforating vessels of the brachial artery muscle septum, and the BAPP flaps were cut out with the detected perforating vessels as the pedicle to repair 19 cases of trunk and upper limb soft tissue defects. There were 12 males and 7 females, with an average age of 28.6 years (range, 5-66 years). Etiologies included the post-burn scar in 10 cases, soft-tissue sarcoma in 5 cases, congenital melanocytic nevi in 2 cases, chronic chest wall ulcer in 1 case, and malignant melanoma in 1 case. Defects located in axilla in 8 cases, chest wall in 4 cases, elbow in 5 cases, and shoulder in 2 cases. The area of the defect ranged from 15 cm×3 cm to 20 cm×8 cm. Pre-transfer tissue expansion was used in 11 patients. Thirteen flaps were pedicled with 1 perforator vessel, and 6 flaps were pedicled with 2 perforator vessels. The length of the vascular pedicle was 2.5-4.5 cm, with an average of 3.08 cm. The area of the skin flap ranged from 11 cm×5 cm to 22 cm×10 cm. The flap rotation angle was 110° in 1 case, 120° in 1 case, and 180° in 17 cases. Except for one donor site repaired by skin graft, the other donor sites were directly sutured.ResultsA total of 24 perforating vessels of the brachial artery muscle septum were detected by ICG angiography, 26 were identified during the operation, with an accuracy rate of 92.31%. Eighteen flaps survived without arteriovenous crisis. Venous congestion was observed in the distal 3-cm of one flap and the flap survived after conservative management. Intraoperative analysis showed that the blood perfusion of the distal 4-cm of one flap was poor, the relative value was less than 32%, the flap survived after removing the poor perfusion area. All the patients were followed up 3 to 23 months (mean, 8.6 months). The color and texture of the flap were similar to those of the recipient area. Flap debulking was not needed in all patients owing to the thinness of the flap. The contracture symptoms of patients with scar contracture on the medial of the elbow joint and axilla were significantly improved; a patient with malignant melanoma underwent tumor resection at 1 year and 5 months after operation due to tumor recurrence, and additional surgery was done to remove the recurrent tumor. No tumor recurrence was found in other patients.ConclusionThe ICG angiography technique can be used to explore the perforating vessels of the brachial artery muscle septum. The BAPP flap pedicled with the perforating vessels can be used for the repair of skin and soft tissue defects in the chest wall, axilla, shoulder, and elbow joint.
ObjectiveTo summarize the application status and progress of indocyanine green fluorescence imaging in laparoscopic anatomic liver resection , and to analyze its advantages, limitations, and prospects.MethodThe literatures about indocyanine green fluorescence imaging in laparoscopic anatomic liver resection were reviewed.ResultsIndocyanine green fluorescence imaging had been preliminarily used in the operation of liver tumors and had shown its unique value in the anatomical liver resection, providing a new way to reduce the recurrence of liver cancer, improve the therapeutic effect, and prolong the survival time of patients.ConclusionsThe clinical application of indocyanine green fluorescence imaging in anatomic liver resection is still at the stage of development and popularization. Although it has unique advantages and development potential, it needs to be further improved in the aspects of tissue penetration, specificity, and staining success rate.
Indocyanine green fluorescence imaging has been widely used in hepatobiliary surgery, which can guide accurate hepatectomy and improve the prognosis of patients. Lipiodol–indocyanine green emulsion as a pure physical way to prepare lipiodol-drug mixed solvent can be used for primary interventional embolization and subsequent fluorescence-guided hepatectomy. In this paper, the application of iodized oil-indocyanine green emulsion in hepatectomy was summarized by reviewing relevant research progress at home and abroad, and further discussion and prospect were made.
Objective To compare the consistency and difference of optical coherence tomography angiography (OCTA) and traditional multimodal fundus imaging in the diagnosis and activity evaluation of choroidal neovascularization (CNV) in exudative age-related macular degeneration (AMD). Methods A total of 112 exudative AMD patients (130 eyes) were included in this retrospective study, 62 were men (71 eyes) and 50 were women (59 eyes). The mean age was (68.250±9.789) years (range 50 – 91 years). All patients were underwent traditional multimodal fundus imaging including fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA) and spectral domain optical coherence tomography (OCT); OCTA was performed at the same time. The CNV type was divided into active and non-active according to the results of traditional multimodal fundus imaging. The vascular pattern was divided into active and non-active according to the results of OCTA. Using traditional multimodal fundus imaging as the standard, the sensitivity and specialty of OCTA was evaluated. Results In 130 eyes, CNV was visualized on traditional multimodal fundus imaging in 109 eyes (83.8%); CNV was visualized on OCTA in 103 eyes (79.2%), which including 7 eyes of false negative and 1 eye of false positive. The sensitivity of OCTA for CNV diagnosis was 93.6%, with specificity of 95.2%. The CNV detection rate between two methods had no significant difference (Youden index=0.89,Kappa value=0.796,P=0.07). In 109 eyes diagnosed with CNV by traditional multimodal fundus imaging, 73 eyes (67.0%) were active CNV and 36 eyes (33.0%) were non-active CNV; the vascular pattern was active in 60 eyes (55.0%) and non-active in 49 eyes (45.0%). The sensitivity of OCTA for the detection of active CNV was 82.2%, with specificity of 100.0%. The active CNV detection rate between two methods had no significant difference (Youden index=0.82,Kappa value=0.753,P=0.00). Conclusion In the diagnosis and activity evaluation of CNV in exudative AMD, there is remarkable consistency between OCTA and traditional multimodal fundus imaging.
ObjectiveTo summarize the application progress of indocyanine green (ICG) angiography in diagnosis and treatment of lymphedema.MethodsThe literature related to dynamic imaging tracing of lymphedema at home and abroad was reviewed extensively. And the research status and progress of ICG angiography in diagnosis and treatment of lymphedema were retrospectively analyzed.ResultsICG angiography can be used as the gold standard for the diagnosis of lymphedema at present and the classification of lymphedema severity, selection of surgical incisions and methods, and intraoperative operation. It can also be used to observe lymphatic drainage and regeneration within 1.5 cm of subcutaneous and determine the prognosis.ConclusionCompared with traditional methods, ICG angiography has more obvious advantages and value in diagnosis and treatment of lymphedema. However, it also has problems such as slow development speed and difficulty in developing deep lymphatic vessels (nodes).