Diep Gustave K, Hui Jane Yuet Ching, Marmor Schelomo, Cunningham Bruce L, Choudry Umar, Portschy Pamela R, Tuttle Todd M
University of Minnesota, Minneapolis, MN, USA.
Department of Surgery, Minneapolis, MN, USA.
Ann Surg Oncol. 2016 Nov;23(12):4080-4085. doi: 10.1245/s10434-016-5466-y. Epub 2016 Jul 27.
Mastectomy flap necrosis is a major complication in patients undergoing tissue expander-based reconstruction. This study compared the complication rates following mastectomy and immediate reconstruction with intraoperative indocyanine green (ICG) angiography evaluation to those with clinical assessment only.
We performed a single-institution retrospective study of mastectomy patients who underwent immediate tissue expander-based reconstruction between September 2009 and December 2013. ICG angiography was adopted in March 2012. The rates of complications in the ICG and clinical assessment only groups were compared. Factors associated with complications were identified with the Fischer exact test and univariate analysis.
A total of 114 patients were identified; clinical assessment only, 53 patients; ICG angiography, 61 patients. The overall complication rates were not significantly different between the two groups (ICG angiography, 50.8 %; clinical assessment, 43.4 %; p = 0.46). There was no significant difference in the rates of unexpected return to the operating room, cellulitis, hematomas, and seromas. The overall rates of flap necrosis were not significantly different (ICG angiography, 27.9 %; clinical assessment, 18.9 %; p = 0.28). However, the rates of severe flap necrosis were significantly lower with intraoperative ICG angiography (4.9 %) than with clinical assessment only (18.9 %, p = 0.02). On univariate analysis, breast weight (≥500 g) was significantly associated with increased rates of severe flap necrosis (p = 0.04), whereas body mass index, age, smoking status, prior breast surgery, history of radiation therapy, and receipt of nipple-sparing mastectomy were not.
We observed that the implementation of intraoperative ICG angiography was associated with a significant decrease in the rate of severe flap necrosis.
乳房切除皮瓣坏死是接受组织扩张器重建患者的主要并发症。本研究比较了术中使用吲哚菁绿（ICG）血管造影评估与仅进行临床评估的乳房切除及即刻重建后的并发症发生率。
我们对2009年9月至2013年12月期间接受即刻组织扩张器重建的乳房切除患者进行了单机构回顾性研究。2012年3月开始采用ICG血管造影。比较了ICG组和仅临床评估组的并发症发生率。采用Fisher精确检验和单因素分析确定与并发症相关的因素。
共纳入114例患者；仅临床评估组53例患者；ICG血管造影组61例患者。两组总体并发症发生率无显著差异（ICG血管造影组为50.8%；临床评估组为43.4%；p = 0.46）。意外返回手术室、蜂窝织炎、血肿和血清肿的发生率无显著差异。皮瓣坏死的总体发生率无显著差异（ICG血管造影组为27.9%；临床评估组为18.9%；p = 0.28）。然而，术中ICG血管造影的严重皮瓣坏死发生率（4.9%）显著低于仅临床评估组（18.9%，p = 0.02）。单因素分析显示，乳房重量（≥500 g）与严重皮瓣坏死发生率增加显著相关（p = 0.04），而体重指数、年龄、吸烟状况、既往乳房手术史、放疗史和保留乳头的乳房切除术则无关。
我们观察到术中ICG血管造影的实施与严重皮瓣坏死发生率的显著降低相关。
