Experince of ICGA-guided breast reconstruction with abdominal flap

Objective This article provides an overview of our experience using indocyanine green angiography (ICGA) in breast reconstruction with abdominal flap to ascertain the application value of ICGA and its usage in decreasing postoperative complications. Methods A total of 21 breast reconstructions with intraoperative ICGA were analyzed retrospectively, including 7 bilateral deep inferior epigastric perforator (DIEP) flaps, 5 pedicled transverse rectus abdominis myocutaneous (TRAM) flaps with contralateral free TRAM flaps, 4 pedicled TRAM flaps with contralateral DIEP flaps, 3 unilateral DIEP flaps and 2 unilateral pedicled TRAM flaps. According to different breast reconstruction methods, ICGA were applied respectively after flap harvesting and vessel anastomosis, in order to evaluate the blood supply of flaps and vessel perfusion. Results A total of 52 ICGA were performed and recorded intraoperatively without any indocyanine green-associated complications. The operation methods were modified according to ICGA findings in 6 of 21 cases. The distal part of flaps were discarded due to poor perfusion in 2 cases (1 DIEP flap and 1 TRAM flap), additional free vessel anastomosis were needed in 2 cases to ensure sufficient blood supply, 2 vascular complication including 1 vascular occlusion and 1 vascular thrombosis were found and managed in time. During the follow-up (range from 3 to 30 months, median of 16 months), no vascular crisis was reported. All flaps survived satisfactorily without partial or whole flap necrosis or wound infection. Conclusions Intraoperative ICGA can provide real-time information of flap′s blood supply and vessel perfusion to evaluate the conditions of flaps and vascular anastomosis, which can help surgeons take actions accordingly to increase the successful rate of breast reconstruction. Key words: Indocyanine green; Breast reconstruction; Surgical flap