Mastectomy Skin Flap Perfusion Assessment Prior to Breast Reconstruction: A Narrative Review

Area of Science:

• Surgical Oncology
• Plastic and Reconstructive Surgery
• Medical Imaging

Background:

• Assessing skin flap viability post-mastectomy is critical for successful immediate breast reconstruction.
• Various methods exist for evaluating flap perfusion, necessitating a comparative review.

Purpose of the Study:

• To describe and compare current preferred perfusion assessment tools for skin flaps after mastectomy.
• To provide an overview of established and emerging techniques in flap viability monitoring.

Main Methods:

• A systematic literature search was conducted across four major databases (Web of Science, PubMed, Embase, Scopus).
• Included studies were reviews, meta-analyses, clinical trials, experimental studies, and case reports published in English within the last 10 years.
• The last search was performed on July 31, 2024.

Main Results:

• Fifty-eight studies were included in the review.
• A synthesis and comparison of relevant information from included studies were performed.
• Indocyanine green angiography (ICG-A) emerged as the most frequently utilized method.

Conclusions:

• Indocyanine green angiography (ICG-A) is the current gold standard for evaluating skin flap perfusion, particularly in high-risk patients.
• Emerging technologies demonstrate potential for future applications in flap viability assessment.
• Perfusion assessment tools should augment, not replace, clinical judgment in patient care.