Outcomes of DIEP Flap and Fluorescent Angiography: A Randomized Controlled Clinical Trial

Area of Science:

• Plastic Surgery
• Surgical Oncology
• Medical Imaging

Background:

• Deep inferior epigastric perforator (DIEP) flap breast reconstruction is prone to complications like fat necrosis.
• Assessing the utility of indocyanine green (ICG) fluorescent angiography to mitigate this risk is crucial.

Purpose of the Study:

• To evaluate the safety and efficacy of ICG fluorescent angiography in reducing fat necrosis in DIEP flap breast reconstruction.
• To compare outcomes between DIEP flaps assessed by clinical evaluation versus angiographic criteria.

Main Methods:

• A parallel, randomized, controlled clinical trial was conducted for unilateral breast reconstruction.
• Flap tissue was excised based on clinical evaluation (Group 1) or angiographic criteria (Group 2).
• Flap dimensions, perfusion (fluorescence intensity), complications, reoperations, and BREAST-Q scores were recorded.

Main Results:

• A significant reduction in fat necrosis was observed in the ICG group (8.3%) compared to the clinical evaluation group (59.3%) (p=0.001).
• The ICG group showed higher flap perfusion rates (p=0.001) and improved BREAST-Q scores.
• No significant differences in flap dimensions or reoperation rates were noted between groups.

Conclusions:

• ICG fluorescent angiography is a safe and effective tool for DIEP flap breast reconstruction, significantly decreasing fat necrosis.
• The technique enhances flap perfusion and improves patient-reported outcomes, including satisfaction and quality of life.
• ICG angiography offers a valuable method to optimize results in DIEP flap procedures.