Use of Indocyanine Green Angiography decreases the risk of complications in autologous- and implant-based breast reconstruction: A systematic review and meta-analysis

Abstract

Introduction: Indocyanine Green Angiography (ICG-A) is an imaging technique used to visualize tissue perfusion in real time. The aim of this systematic review and meta-analysis is to evaluate all published papers on breast reconstruction using ICG-A, which provides information on complication rates and to investigate whether the use of this peroperative method decreases the risk of complications. Materials and Methods: MEDLINE/PubMed, EMBASE, Cochrane, and UpToDate were searched using relevant terms. The literature was assessed using the PRISMA guidelines. Inclusion criteria were: original articles written in English assessing ICG-angiography in breast reconstruction. The individual studies were evaluated according to Cochrane guidelines. Results: The search yielded 243 papers on ICG-A and breast reconstruction. Twenty-six of these were included for analysis. The risk of overall major complications ([OR] = 0.53, 95% confidence interval (CI) = 0.43-0.66, p = 0.00001) and overall loss of reconstruction ([OR] = 0.58, 95% CI = 0.37-0.92, and p = 0.020) was significantly lower when peroperative ICG-A was used. When using ICG-A to evaluate mastectomy flaps, a statistically lower risk of major complications ([OR] = 0.56 and p = 0.0001) and the loss of reconstruction was found ([OR] = 0.46, p = 0.006).

Role of Qualitative and Quantitative Indocyanine Green Angiography to Assess Mastectomy Skin Flaps Perfusion in Nipple/Skin-Sparing and Skin-Reducing Mastectomies with Implant-Based Breast Reconstruction

“…They found evidence that qualitative ICG angiography could decrease reoperation rates (RR 0.50, 95% CI 0.35 to 0.72; four studies, 613 participants). Moreover, a review and meta-analysis by Lauritzen and Damsgaard [ 26 ] describes how the IBR performed with ICG angiography to evaluate MSF showed a significantly lower risk of major complications, defined as complications requiring surgery/debridement in local or general anesthesia, hematoma, and loss of reconstruction ([OR] = 0.56; 95% CI (0.42–0.76), and p =0.0001) as well as a lower risk of reconstruction failure ([OR] = 0.46; 95% CI (0.27–0.82), and p =0.0006). The risk of minor complications, defined as ones requiring only conservative treatment, was not significantly reduced ([OR] = 1.05, 95% CI (0.79–1.4), and p =0.7).…”

Immediate direct-to-implant breast reconstruction with acellular dermal matrix: Evaluation of complications and safety

“…We did not use intraoperative evaluation of skin perfusion with intravenous indocyanine green fluorescence (ICG), which could potentially have saved us from some cases of necrosis/impaired healing; some of the patients with questionable skin perfusion might have been deemed unfit for one-stage reconstruction with ADM and re-directed to two-stage reconstruction with expander. A recent meta-analysis document that the risk of major complications and implant loss can be lowered significantly with the use of ICG [ 29 ].…”

Implant-Based Breast Reconstruction after Mastectomy, from the Subpectoral to the Prepectoral Approach: An Evidence-Based Change of Mind?

“…Several techniques have been described to increase the survival rate and tissue quality of mastectomy flaps; for instance, there is the use of local heat preconditioning [ 92 , 93 ] or hyperbaric oxygen therapy [ 94 ]. Furthermore, the development and clinical implication of intraoperative indocyanine green angiography (ICG) for the real time visualization of tissue perfusion has been another crucial step toward perfecting prepectoral IBBR [ 95 ]. The immediate intraoperative assessment of the perfusion of the mastectomy skin flap to guide excision of inadequately perfused areas has since translated to improved clinical outcomes.…”