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Indocyanine green laser angiography improves outcomes in DIEP flaps

Indocyanine green angiography was found to be a helpful vascular imaging modality for intraoperatively assessing flap perfusion, in addition to helping improve outcomes in deep inferior epigastric perforator flaps when harvested after prior abdominal suction lipectomy, according to researchers.

The researchers retrospectively reviewed outcomes from a series of 13 deep inferior epigastric perforator (DIEP) flaps performed between July 2003 and January 2014 for autologous breast reconstruction following prior abdominal suction lipectomy in 11 patients. Among the outcomes measured were anastomotic complications, total flap loss, partial flap loss, fat necrosis and postoperative abdominal wounds. On average, follow-up lasted 22 months.

The researchers evaluated seven of the flaps intraoperatively based on clinical grounds only, and six were assessed and modified on the basis of indocyanine green angiography.

Indocyanine green laser angiography was performed at the beginning of the procedure and repeated afterflap elevation was complete but before transfer with excision of areas of hypoperfusion. Following the completion of anastomoses, laser angiography was used once again to test anastomotic patency, along with the adequacy of flap perfusion

Substantial partial flap loss and fat necrosis occurred in five of seven flaps evaluated clinically. Four of the seven DIEP flaps required augmentation subsequently in order to provide sufficient breast volume and contour, according to the researchers.

In the six flaps assessed with indocyanine green angiography, all were transferred successfully without any anastomotic complications, total flap losses, partial flap loss or fat necrosis, the researchers reported.

No difference was found in the rate of anastomotic complications or total flap loss in those assessed clinically compared with those utilizing indocyanine green laser angiography. However, the researchers found a statistically significant decrease in the rate of partial flap loss and fat necrosis in flaps where laser angiography was used to monitor flap perfusion. - by Abigail Sutton

Disclosure: The researchers report no relevant financial disclosures.