Can indocyanine green perfusion imaging detect microangiopathy in mastectomy skin flaps?

Intraoperative vascular imaging using indocyanine green (ICG) angiography may better predict flap viability than clinical judgement alone. Intraoperative ICG angiography was used in a chronic corticosteroid user undergoing bilateral nipple sparing mastectomy with expander placement. Large blood vessels were visualized, however, the skin surrounding these vessels remained dark. The flap demarcated to full-thickness necrosis that matched the intraoperative SPY findings. Visualization of intact blood vessels may not be sufficient to rule out flap necrosis in some patients. In these circumstances, interpretation of perfusion with consideration of patient factors will be required to accurately predict flap viability.