A Comparison of Methods to Assess Mastectomy Flap Viability in Skin-Sparing Mastectomy and Immediate Reconstruction

Rinker, Brian

doi:10.1097/01.prs.0000475744.10344.1e

Cited by 47 publications

(63 citation statements)

References 39 publications

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“…This may also account for the findings of Rinker33, who compared rates of mastectomy flap necrosis using all three modalities (clinical judgement, ICGA and FA) and reported a necrosis rate of 3 per cent and reoperation rate of 0 per cent with use of FA, which was the lowest of all techniques ( Table 1). If all tissues with a mottled appearance were excised as described in the former two studies37 39, a low necrosis rate is to be expected owing to over‐resection of potentially viable tissue.…”

Section: Resultsmentioning

confidence: 87%

“…1). After detailed examination of 30 full‐text articles, 18 studies7 19, 20 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, including 2077 patients, were included in this review.…”

Section: Resultsmentioning

confidence: 99%

“…One was to compare rates of mastectomy necrosis and other complications, such as reoperation rates, and clinical outcomes between the techniques used ( Table 1). Seven case series7 28, 29, 30, 31, 32 34 and one cohort study33 used this approach. The alternative approach in seven prospective cohort studies19 20, 35, 36, 37, 38, 39 was to evaluate flap perfusion using the intraoperative modalities and to record the predicted areas of necrosis using photographic documentation or video recording.…”

Section: Resultsmentioning

confidence: 99%

“…Mastectomy flap necrosis rates were compared with clinical judgement in seven7 28, 29, 30, 31, 32, 33 studies using ICGA, one study using FA33 and one pilot study using ODIS34. Use of ICGA in 652 and FA in 34 breasts resulted in a decrease in mean mastectomy flap necrosis compared with clinical judgement in 1964 breasts (7·9 and 3 compared with 19·4 per cent) ( Table 3).…”

Section: Resultsmentioning

confidence: 99%

“…If all tissues with a mottled appearance were excised as described in the former two studies37 39, a low necrosis rate is to be expected owing to over‐resection of potentially viable tissue. Indeed, the mean area of resection was larger when FA was used than with use of ICGA (6·2 versus 5·4 cm 2 respectively), although the difference was not statistically significant33. In a series of 50 consecutive SSMs with autologous reconstruction39, a recommendation was therefore made to consider additional variables related to flap survival, such as surface area, previous irradiation and location of non‐fluorescence, when deciding resection margins.…”

Section: Resultsmentioning

confidence: 99%

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Systematic review of methodologies used to assess mastectomy flap viability

et al. 2018

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BackgroundAccurate prediction of mastectomy skin flap viability is vital as necrosis causes significant morbidity, potentially compromising results and delaying oncological management. Traditionally assessed by clinical judgement, a more objective evaluation can be provided using intraoperative imaging modalities. This systematic review aimed to compare all intraoperative techniques for assessment of mastectomy flap viability.MethodsA systematic literature review was performed using MEDLINE and Embase databases. Primary outcomes reported included specificity, sensitivity and predictive values of each test, and mean rates of mastectomy flap necrosis and reoperation. Secondary outcomes included cost analysis.ResultsSome 18 studies were included. Designs were prospective cohort study (8), retrospective case series (4), prospective case series (3), retrospective case–control study (1), prospective pilot trial (1) and cost analysis study (1). The studies compared indocyanine green angiography (ICGA) (16 studies) and fluorescein dye angiography (FA) (3 studies) with clinical judgement. Sensitivity and specificity were highest for ICGA (5 studies) ranging from 38 to 100 and 68 to 91 per cent respectively. Both methods overpredicted necrosis. Mean rates of flap necrosis and reoperation decreased with ICGA (7·9 and 5·5 per cent respectively) and FA (3 and 0 per cent) compared with clinical judgement (19·4 and 12·9 per cent). Two studies were designed to define numerical parameters corresponding to perfusion using intraoperative techniques. Two studies performed a cost analysis for ICGA; one claimed a cost benefit and the other advocated its use in high‐risk patients only.ConclusionICGA and FA are potentially useful tools for mastectomy flap assessment. However, the predictive accuracy is subject to the specific settings and model of equipment used. Current recommendations support their use in high‐risk patients.

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Section: Resultsmentioning

confidence: 87%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Systematic review of methodologies used to assess mastectomy flap viability

et al. 2018

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Indocyanine green angiography for preventing postoperative mastectomy skin flap necrosis in immediate breast reconstruction

Pruimboom

Schols

Kuijk

et al. 2020

Cochrane Database of Systematic Reviews

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Predictors of complications after direct-to-implant breast reconstruction with an acellular dermal matrix from a multicentre randomized clinical trial

Negenborn

Dikmans

Bouman

et al. 2018

British Journal of Surgery

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BackgroundIn the multicentre randomized trial BRIOS (Breast Reconstruction In One Stage), direct‐to‐implant (DTI) breast reconstruction with an acellular dermal matrix (ADM) was associated with a markedly higher postoperative complication rate compared with two‐stage tissue expander/implant breast reconstruction. This study aimed to identify factors that contribute to the occurrence of complications after DTI ADM‐assisted breast reconstruction.MethodsData were obtained from the BRIOS study, including all patients treated with DTI ADM‐assisted breast reconstruction. Logistic regression analyses were performed to identify factors predictive of postoperative complications.ResultsFifty‐nine patients (91 breasts) were included, of whom 27 (35 breasts) developed a surgical complication. Reoperations were performed in 29 breasts (32 per cent), with prosthesis removal in 22 (24 per cent). In multivariable analyses, mastectomy weight was associated with complications (odds ratio (OR) 1·94, 95 per cent c.i. 1·33 to 2·83), reoperations (OR 1·70, 1·12 to 2·59) and removal of the implant (OR 1·55, 1·11 to 2·17). Younger patients (OR 1·07, 1·01 to 1·13) and those who received adjuvant chemotherapy (OR 4·83, 1·15 to 20·24) more frequently required reoperation. In univariable analyses, adjuvant radiotherapy showed a trend towards more complications (OR 7·23, 0·75 to 69·95) and removal of the implant (OR 5·12, 0·76 to 34·44), without reaching statistical significance.ConclusionBreast size appeared to be the most significant predictor of complications in DTI ADM‐assisted breast reconstruction. The technique should preferably be performed in patients with small to moderate sized breasts. Registration number: NTR5446 ( http://www.trialregister.nl).

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A Comparison of Methods to Assess Mastectomy Flap Viability in Skin-Sparing Mastectomy and Immediate Reconstruction

Abstract: Therapeutic, II.

Cited by 47 publications

References 39 publications

Systematic review of methodologies used to assess mastectomy flap viability

Systematic review of methodologies used to assess mastectomy flap viability

Indocyanine green angiography for preventing postoperative mastectomy skin flap necrosis in immediate breast reconstruction

Predictors of complications after direct-to-implant breast reconstruction with an acellular dermal matrix from a multicentre randomized clinical trial

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