Plastic-Reconstructive and Lymphedema Microsurgery Center, Mater Olbia Hospital, Olbia, Italy.
Department of Medical, Surgical and Experimental Sciences, Plastic Surgery Unit, University of Sassari, Sassari University Hospital Trust, Sassari, Italy.
Clin Breast Cancer. 2024 Dec;24(8):755-762. doi: 10.1016/j.clbc.2024.08.024. Epub 2024 Sep 4.
This study investigates the predictive role of indocyanine green angiography and thermography in assessing mastectomy skin flap necrosis in the intraoperative and postoperative setting.
A retrospective review of 45 patients who underwent nipple-sparing mastectomy and immediate prepectoral reconstruction was performed. Mastectomy flap viability was evaluated intraoperatively with indocyanine green angiography and thermography after placement of an implant sizer and again postoperatively at 24 hours. Fluorescence pattern was analyzed with a near-infrared camera (IC-Flow Imaging System, Diagnostic Green GmbH, Germania) and thermographic images with FLIR ONE device. FLIR ONE and ICG images were then transposed on macroscopic breast images with a scale 1:1. The mastectomy skin flap was evaluated using the SKIN score (Mayo Clinic Classification).
Overlap between angiography and thermography images was 87.95% intraoperatively and 95.95% 24 hours postoperatively. Overlay with mastectomy flap necrosis was higher in the intraoperative angiography group with statistical significance. Contrarily, such a difference was not apparent in the postoperative period.
ICG appears to be a superior tool when used intraoperatively with fundamental implications on reconstructive decision-making, while thermography could be a valuable assessment method in the postoperative setting. Further studies are necessary to confirm such results and determine their clinical applicability.
本研究旨在探讨吲哚菁绿血管造影和热成像在评估乳房切除术皮瓣坏死中的预测作用，分别在术中及术后进行评估。
回顾性分析了 45 例行保留乳头的乳房切除术和即刻胸肌前置重建术的患者。术中在放置植入物扩压器后，使用吲哚菁绿血管造影和热成像评估乳房切除术皮瓣的存活情况，并在术后 24 小时再次进行评估。使用近红外相机（IC-Flow Imaging System，Diagnostic Green GmbH，德国）分析荧光模式，使用 FLIR ONE 设备分析热成像图像。然后将 FLIR ONE 和 ICG 图像与宏观乳房图像以 1:1 的比例进行转换。使用 SKIN 评分（Mayo 诊所分类）评估乳房切除术皮瓣。
术中血管造影和热成像图像的重叠率为 87.95%，术后 24 小时为 95.95%。术中血管造影组的皮瓣坏死重叠率更高，具有统计学意义。相反，在术后期间，这种差异并不明显。
ICG 在术中使用时似乎是一种更好的工具，对重建决策具有重要意义，而热成像在术后评估中可能是一种有价值的评估方法。需要进一步的研究来证实这些结果，并确定其临床适用性。
