Postmastectomy Reconstruction Outcomes After Intraoperative Evaluation with Indocyanine Green Angiography Versus Clinical Assessment

Diep, Gustave K; Hui, Jane Yuet Ching; Marmor, Schelomo; Cunningham, Bruce L.; Choudry, Umar; Portschy, Pamela R.; Tuttle, Todd M.

doi:10.1245/s10434-016-5466-y

Cited by 52 publications

(64 citation statements)

References 29 publications

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“…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%

“…Use of ODIS in five patients resulted in a mastectomy flap necrosis rate of 20 per cent34. Studies varied in their classification of skin necrosis; some did not offer a definition, whereas others30 32, 35 used a scoring system such as mild, moderate or severe, with a description of what was meant by these terms.…”

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: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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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“…In most studies, intraoperative management was guided by clinical observations and imaging results, limiting assessment of its predictive value. 3,4,6,9 We correlated intraoperative perfusion measurements with clinical outcomes without allowing intraoperative ICG data to influence surgical management.…”

Section: Introductionmentioning

confidence: 99%

SPY Elite’s Ability to Predict Nipple Necrosis in Nipple-Sparing Mastectomy and Immediate Tissue Expander Reconstruction

Venturi

Mesbahi

Copeland-Halperin

et al. 2017

Plastic and Reconstructive Surgery - Global Open

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Background:Nipple-sparing techniques have improved the aesthetics of reconstruction following mastectomy, but nipple necrosis complicates up to 37% of procedures, distressing patients, delaying adjuvant therapy, and compromising outcomes. No method reliably detects nipple necrosis better than clinical assessment of tissue perfusion. We prospectively assessed the accuracy of intraoperative indocyanine green laser angiography to predict nipple necrosis.Methods:Twenty consecutive women undergoing immediate tissue expander breast reconstruction following 32 nipple-sparing mastectomies underwent indocyanine green fluorescence imaging to assess nipple perfusion immediately before and after intraoperative tissue expansion. Imaging findings were correlated with postoperative nipple viability.Results:Among the 32 nipple-sparing mastectomies (8 unilateral, 12 bilateral) in 20 women (mean age, 48 years), partial or full-thickness necrotic changes developed in 3 breasts of 2 patients (10%). Imaging identified impaired perfusion and predicted necrosis in these cases.Conclusions:In this initial series, intraoperative indocyanine green laser angiography correctly identified patients who developed nipple necrosis during mastectomy and tissue expander breast reconstruction.

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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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Postmastectomy Reconstruction Outcomes After Intraoperative Evaluation with Indocyanine Green Angiography Versus Clinical Assessment

Abstract: We observed that the implementation of intraoperative ICG angiography was associated with a significant decrease in the rate of severe flap necrosis.

Cited by 52 publications

References 29 publications

Systematic review of methodologies used to assess mastectomy flap viability

Systematic review of methodologies used to assess mastectomy flap viability

SPY Elite’s Ability to Predict Nipple Necrosis in Nipple-Sparing Mastectomy and Immediate Tissue Expander Reconstruction

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

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