Stanford, Calif. From the Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University.
Plast Reconstr Surg. 2010 Apr;125(4):1065-1073. doi: 10.1097/PRS.0b013e3181d17f80.
Immediate breast reconstruction results in a superior cosmetic outcome. However, immediate breast reconstruction using both prosthetic and autologous techniques is associated with significantly higher complication rates than delayed procedures. These early postoperative complications are usually related to unrecognized ischemia of mastectomy skin and/or inadequate perfusion of autologous tissue used for reconstruction. Aside from clinical experience, there are no reliable tools to assist the novice surgeon with intraoperative assessment of tissue viability.
Laser-assisted indocyanine green imaging was applied to determine and map tissue perfusion. Indocyanine green perfusion mapping was used in 24 consecutive breast reconstructions to define the perfusion of both mastectomy skin and autologous tissue. Areas of inadequate perfusion were then removed at the time of surgery. Postoperative complications occurring within 90 days after surgery were reviewed.
In 24 consecutive breast reconstruction (16 tissue expanders, two latissimus dorsi flaps, and six deep inferior epigastric perforator/superficial inferior epigastric arteries), there was a 4 percent complication rate. Intraoperatively, the use of indocyanine green imaging allowed all poorly perfused skin to be removed completely in each case, minimizing the incidence of mastectomy flap necrosis, partial necrosis of autologous tissue, and impaired healing. For autologous reconstruction, patency of anastomoses could also be confirmed. This complication rate was significantly less than the 15.1 percent complication rate observed in 206 reconstructions in the previous consecutive 148 patients (p < 0.01) with similar demographics and risk factors.
This early experience demonstrates an increased accuracy in predicting tissue necrosis (mastectomy flap, autologous tissue) as guided by indocyanine green imaging. Further prospective studies are warranted to quantify whether this technology can reduce health care costs by preventing complications in immediate breast reconstruction.
即刻乳房重建可获得更好的美容效果。然而，即刻乳房重建同时使用假体和自体技术与延迟手术相比，并发症发生率显著更高。这些早期术后并发症通常与未被识别的乳房切除术皮瓣缺血和/或用于重建的自体组织灌注不足有关。除了临床经验外，目前还没有可靠的工具可以帮助新手外科医生在术中评估组织活力。
应用激光辅助吲哚菁绿成像来确定和绘制组织灌注情况。吲哚菁绿灌注成像用于 24 例连续乳房重建，以确定乳房切除术皮瓣和自体组织的灌注情况。然后在手术时切除灌注不足的区域。回顾术后 90 天内发生的并发症。
在 24 例连续乳房重建（16 例组织扩张器、2 例背阔肌皮瓣和 6 例腹壁下动脉穿支/浅动脉皮瓣）中，并发症发生率为 4%。术中使用吲哚菁绿成像可确保在每种情况下完全切除所有灌注不良的皮肤，最大限度地减少乳房切除术皮瓣坏死、自体组织部分坏死和愈合不良的发生率。对于自体重建，也可以确认吻合口的通畅性。与之前 148 例连续 206 例患者（p < 0.01）相似的人口统计学和危险因素相比，该并发症发生率显著降低。
这项早期经验表明，吲哚菁绿成像引导下预测组织坏死（乳房切除术皮瓣、自体组织）的准确性有所提高。需要进一步的前瞻性研究来量化这项技术是否可以通过预防即刻乳房重建中的并发症来降低医疗保健成本。
