Zikiryakhodzhaev A D, Moshurova M V, Balayan E O, Timoshkin V O
P.A. Herzen Moscow Oncology Research Institute - branch of the National Medical Research Center of Radiology, Moscow, Russia.
Khirurgiia (Mosk). 2024(8):34-40. doi: 10.17116/hirurgia202408134.
The use of allotransplants for breast reconstruction in surgical stage of the the breast cancer treatment requires tissue perfusion control. The aim of the study was to analyze the effectiveness of using indocyanine green as a drug for determining the perfusion of perforant flaps in breast reconstructive surgery.
A retrospective series of observations of 27 breast reconstructions using autologous transplants is presented: 19 reconstructions with DIEP-flap, 2 with SIEA-flap, 5 with TD-flap; 1 with thoracoepigastric flap. Intraoperative fluorescence angiography was performed using a Stryker device (5900 Optical Court, USA). The intensity of the flap fluorescence was recorded after intravenous bolus injection of 7.5 mg indocyanine green.
The optimal time interval from the moment of drug administration to indicative visualization of flap perfusion was 55-60 seconds. In all patients, the area of insufficient blood flow was excised within intensively blood-supplied tissues, according to mapping data with the indocyanine green. With free transplant of flaps postoperative complications during follow-up were recorded in 1 (4.8%) case (marginal necrosis), which is associated with insufficient compression of auxiliary vessels (violation of the dominant vessel contrast technique). With non-free transplant of flaps no complications were detected in the postoperative period.
Indocyanine green allows to prevent necrotic changes and reduce the rehabilitation period. The optimal time for the indicative visualization of flap perfusion was 55-60 seconds. The use of indocyanine green in free transplant of flaps ensured a postoperative period without complications in 20 (95.2%) cases, in non-free flap transplantation - in 6 (100%) cases.
在乳腺癌治疗的手术阶段，使用同种异体移植进行乳房重建需要控制组织灌注。本研究的目的是分析使用吲哚菁绿作为一种药物来确定乳房重建手术中穿支皮瓣灌注情况的有效性。
呈现了一组对27例使用自体移植进行乳房重建的回顾性观察：19例使用腹壁下动脉穿支皮瓣（DIEP皮瓣）重建，2例使用腹壁浅动脉皮瓣（SIEA皮瓣）重建，5例使用胸背动脉穿支皮瓣（TD皮瓣）重建；1例使用胸腹皮瓣重建。术中使用史赛克设备（美国密歇根州卡拉马祖市5900光学广场）进行荧光血管造影。静脉推注7.5毫克吲哚菁绿后记录皮瓣荧光强度。
从给药时刻到皮瓣灌注指示性可视化的最佳时间间隔为55 - 60秒。在所有患者中，根据吲哚菁绿的映射数据，在血供丰富的组织内切除了血流不足的区域。皮瓣游离移植时，随访期间记录到1例（4.8%）术后并发症（边缘坏死），这与辅助血管压迫不足（主导血管造影技术违规）有关。皮瓣非游离移植时，术后未检测到并发症。
吲哚菁绿可预防坏死性改变并缩短康复期。皮瓣灌注指示性可视化的最佳时间为55 - 60秒。在皮瓣游离移植中使用吲哚菁绿确保了20例（95.2%）患者术后无并发症，在皮瓣非游离移植中 - 6例（100%）患者术后无并发症。
