Mirhaidari Shayda J, Beddell Gregory M, Orlando Marc V, Parker Michael G, Pedersen John C, Wagner Douglas S
Plastic & Reconstructive Surgery, Summa Health System, Akron, Ohio.
Plastic & Reconstructive Surgery, Akron General Medical Center, Akron, Ohio.
Plast Reconstr Surg Glob Open. 2018 Sep 6;6(9):e1774. doi: 10.1097/GOX.0000000000001774. eCollection 2018 Sep.
Complication rates following immediate breast reconstruction range from 4% to 60%. Mastectomy skin flap necrosis (MSFN) is often the sentinel event leading to secondary complications.
All patients undergoing immediate reconstruction were enrolled. Upon mastectomy completion, the surgeon visually interpreted the skin flaps, performed laser-assisted indocyanine green angiography (LAIGA), and intervened if needed. Patients were followed for 90 days, documenting skin necrosis, infection, seroma, hematoma, implant loss, and reoperation.
There were 126 patients who had 206 immediate breast reconstructions. The complication rate was 22.3%. The incidence of MSFN was 14.1%. The reoperation rate was 8.7%. There was 1 necrosis-related implant loss. Postoperative surveys were completed on 193 breasts: 137 had visual and LAIGA interpretation of well or adequately perfused, resulting in 5.8% rate of necrosis, 2 reoperations, and no implant losses. Twenty breasts had visual and LAIGA interpretation of marginal or poor perfusion. Sixteen of these underwent intervention. The necrosis rate in this group was 35% with no implant losses. A third group with 26 breasts had adequate visual interpretation with marginal or poor perfusion on LAIGA. Ten breasts had no intervention, and 16 received intervention. The overall necrosis rate in this group was 42.3%, with 4 reoperations for necrosis and 1 implant loss.
LAIGA can more accurately predict complications from MSFN than surgeon assessment alone. When surgeon decision making is supplemented with LAIGA, it reduces the incidence of MSFN, infection, implant loss, and overall unexpected reoperation rate. LAIGA is a valuable adjunct for intraoperative decision making.
即刻乳房重建后的并发症发生率在4%至60%之间。乳房切除皮瓣坏死（MSFN）通常是导致继发并发症的哨兵事件。
纳入所有接受即刻重建的患者。乳房切除完成后，外科医生对皮瓣进行视觉评估，进行激光辅助吲哚菁绿血管造影（LAIGA），并在需要时进行干预。对患者进行90天的随访，记录皮肤坏死、感染、血清肿、血肿、植入物丢失和再次手术情况。
126例患者进行了206次即刻乳房重建。并发症发生率为22.3%。MSFN的发生率为14.1%。再次手术率为8.7%。有1例与坏死相关的植入物丢失。对193个乳房进行了术后调查：137个乳房经视觉和LAIGA评估血运良好或充足，坏死率为5.8%，2例再次手术，无植入物丢失。20个乳房经视觉和LAIGA评估血运边缘或较差。其中16个进行了干预。该组坏死率为35%，无植入物丢失。第三组26个乳房视觉评估良好，但LAIGA显示血运边缘或较差。10个乳房未干预，16个接受了干预。该组总体坏死率为42.3%，4例因坏死再次手术，1例植入物丢失。
与单纯外科医生评估相比，LAIGA能更准确地预测MSFN的并发症。当外科医生的决策辅以LAIGA时，可降低MSFN、感染、植入物丢失的发生率以及总体意外再次手术率。LAIGA是术中决策的有价值辅助手段。
