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25-04-2024 | Mastectomy | Research

Indocyanine green angiography guidance for vascular preservation in skin and nipple sparing mastectomy

Authors: Thor S. Stead, Connie Y. Lu, Abby Geletzke, Elizabeth Butler, Ashley Stuckey, David A. Edmonson, Jennifer S. Gass

Published in: Breast Cancer Research and Treatment

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Abstract

Purpose

The skin and/or nipple-sparing approach has become an oncologically sound and desirable choice for women choosing mastectomy. Indocyanine green (ICG) perfusion imaging has been shown to reduce ischemic complications in mastectomy skin flaps. Immediate reconstruction requires a well-vascularized skin flap capable of tolerating full expansion. Identification of the perforating subcutaneous vessels to the skin envelope may allow for better and more consistent blood vessel preservation and flap perfusion.

Methods

The authors conducted an institutional review board-approved prospective study with 41 patients to assess the feasibility of using ICG perfusion imaging to visualize, cutaneously map, and preserve the vessels that supply the skin flap and nipple-areolar complex. For each patient, the number of vessels initially mapped, the number of vessels preserved, the extent to which each vessel was preserved, and the proportion of the flap with adequate perfusion (as defined by the SPY-Q > 20% threshold) was recorded and analyzed.

Results

Vessels were able to be identified and marked in a high majority of patients (90%). There was a moderate linear relationship between the number of vessels marked and the number preserved. Successful mapping of vessels was associated with lower rates of wound breakdown (p = 0.036). Mapping and preserving at least one vessel led to excellent flap perfusion (> 90%). No increase in complications was observed from utilizing ICG angiography preoperatively.

Conclusion

This prospective study using preoperative ICG perfusion mapping demonstrated safety, feasibility, and good prognostic outcomes.

Level of evidence

III.
Footnotes
1
As stated by Diagnostic Green: "a patient with a known allergy to macromolecular iodide/iodine containing compounds will not be at risk of an allergic reaction to ICG where the salt sodium iodide is incorporated." Joanne Renew. (2020, August 25). Indocyanine Green and Iodine/Iodide allergies. Diagnostic Green RoW. https://​diagnosticgreen.​com/​row/​news/​indocyanine-green-and-iodine-iodide-allergies/​
 
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Metadata
Title
Indocyanine green angiography guidance for vascular preservation in skin and nipple sparing mastectomy
Authors
Thor S. Stead
Connie Y. Lu
Abby Geletzke
Elizabeth Butler
Ashley Stuckey
David A. Edmonson
Jennifer S. Gass
Publication date
25-04-2024
Publisher
Springer US
Published in
Breast Cancer Research and Treatment
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI
https://doi.org/10.1007/s10549-024-07326-6
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