The Impact Of Indocyanine Green Angiography On Fat Necrosis In Deep Inferior Epigastric Perforator Flap Breast Reconstruction

Authors

Aran Yoo, LSU Health Sciences Center - New OrleansFollow
Patrick A. Palines, LSU Health Sciences Center - New OrleansFollow
James L. Mayo, LSU Health Sciences Center - New Orleans
Matthew J. Bartow, LSU Health Sciences Center - New Orleans
Denise M. Danos, LSU Health Sciences Center - New OrleansFollow
Hugo St Hilaire, LSU Health Sciences Center - New OrleansFollow
Matthew W. Wise, LSU Health Sciences Center - New OrleansFollow
Mark W. Stalder, LSU Health Sciences Center - New OrleansFollow

Document Type

Article

Publication Date

4-1-2022

Publication Title

Annals of Plastic Surgery

Abstract

Background The deep inferior epigastric perforator flap (DIEP) is a widely known reliable option for autologous breast reconstruction. One common complication of DIEP procedures is fat necrosis. Consequences of fat necrosis include wound healing complications, pain, infection, and the psychological distress of possible cancerous recurrence. Clinical judgment alone is an imperfect method to detect at-risk segments of adipose tissue. Objective methods to assess perfusion may improve fat necrosis complication rates, reducing additional surgeries to exclude cancer and improve cosmesis for patients. Methods The authors performed a retrospective review of patients who underwent analysis of DIEP flap vascularity with or without intraoperative indocyanine green angiography (ICGA). Flap perfusion was assessed using intravenous ICGA and was quantified with both relative and absolute value units of fluorescence. Tissue with observed values less than 25% to 30% relative value units was resected. Postoperative outcomes and fat necrosis incidence were collected. Results Three hundred fifty-five DIEP flaps were included in the study, 187 (52.7%) of which were assessed intraoperatively with ICGA. Thirty-nine patients (10.9%) experienced operable fat necrosis. No statistically significant difference in incidence of postoperative fat necrosis was found between the 2 groups (P = 0.732). However, a statistically significant relationship was found between fat necrosis incidence and body mass index as both a continuum (P = 0.001) and when categorized as greater than 35 (P = 0.038). Conclusions Although ICGA is useful for a variety of plastic surgery procedures, our retrospective review did not show a reduction in operable fat necrosis when using this technology.

First Page

415

Last Page

419

PubMed ID

34611093

Volume

88

Issue

4

Recommended Citation

Yoo, Aran; Palines, Patrick A.; Mayo, James L.; Bartow, Matthew J.; Danos, Denise M.; St Hilaire, Hugo; Wise, Matthew W.; and Stalder, Mark W., "The Impact Of Indocyanine Green Angiography On Fat Necrosis In Deep Inferior Epigastric Perforator Flap Breast Reconstruction" (2022). School of Medicine Faculty Publications. 1095.
https://digitalscholar.lsuhsc.edu/som_facpubs/1095