术中激光辅助吲哚菁绿成像可降低显微乳房重建中脂肪坏死的发生率。

Intraoperative Laser-Assisted Indocyanine Green Imaging Can Reduce the Rate of Fat Necrosis in Microsurgical Breast Reconstruction.

机构信息

From the Division of Plastic and Reconstructive Surgery, Stanford University Medical Center.

出版信息

Plast Reconstr Surg. 2020 Mar;145(3):507e-513e. doi: 10.1097/PRS.0000000000006547.

DOI:10.1097/PRS.0000000000006547

PMID:32097299

Abstract

BACKGROUND

Fat necrosis following microsurgical breast reconstruction is common and problematic for patients and surgeons alike. Indocyanine green angiography provides a means of evaluating flap perfusion at the time of surgery to inform judicious excision of hypoperfused tissue. The authors hypothesized that incorporation of protocolized indocyanine green-informed flap débridement at the time of surgery would decrease the incidence of fat necrosis.

METHODS

A retrospective study of two cohorts was performed evaluating patients before and after implementation of protocolized indocyanine green-guided flap excision. Variables included demographics, procedural details, and complications. Multivariable analysis was used to determine significant differences between the cohorts and evaluate for meaningful changes in fat necrosis.

RESULTS

Eighty patients were included, accounting for 137 flaps. Flap type was the only significant difference between the two groups, with the indocyanine green group more likely to be deep inferior epigastric perforator flaps (43.1 percent versus 25.3 percent; p = 0.038). The overall postoperative incidence of fat necrosis was 14.6 percent (20 of 137 flaps). Comparing by cohort, the standard débridement group showed 18 of 79 flaps with fat necrosis (22.8 percent), whereas the indocyanine green-informed débridement group showed only two of 58 flaps with fat necrosis (3.4 percent; odds ratio, 0.11; 95 percent CI, 0.02 to 0.60; p = 0.011). There were no other significant differences in complication profile.

CONCLUSIONS

Intraoperative use of indocyanine green angiography was associated with significantly lower odds of fat necrosis. This technology may reduce additional revision operations and improve patient satisfaction. Additional studies are needed to determine whether this innovation is cost-effective and generalizable to the entire autologous breast reconstruction population.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

摘要

背景

显微乳房重建术后脂肪坏死很常见，这对患者和外科医生来说都是一个问题。吲哚菁绿血管造影术可在手术时评估皮瓣灌注情况，从而明智地切除灌注不足的组织。作者假设在手术时纳入基于吲哚菁绿的皮瓣清创术的方案会降低脂肪坏死的发生率。

方法

对两组病例进行回顾性研究，评估方案实施前后采用吲哚菁绿引导皮瓣切除的患者。变量包括人口统计学资料、手术细节和并发症。采用多变量分析确定两组之间的显著差异，并评估脂肪坏死的显著变化。

结果

共纳入 80 例患者，共 137 个皮瓣。皮瓣类型是两组之间唯一的显著差异，吲哚菁绿组更可能是深部腹壁下血管穿支皮瓣（43.1%比 25.3%；p = 0.038）。总的术后脂肪坏死发生率为 14.6%（20/137 个皮瓣）。按队列比较，标准清创组有 18/79 个皮瓣发生脂肪坏死（22.8%），而吲哚菁绿引导清创组只有 2/58 个皮瓣发生脂肪坏死（3.4%；优势比，0.11；95%置信区间，0.02 至 0.60；p = 0.011）。并发症情况没有其他显著差异。