Developing an Indocyanine Green Angiography Protocol for Predicting Flap Necrosis During Breast Reconstruction

Area of Science:

• Plastic Surgery
• Surgical Oncology
• Medical Imaging

Background:

• Indocyanine green angiography (ICGA) shows promise in predicting mastectomy skin flap necrosis.
• Optimal ICGA protocols for breast reconstruction lack consensus.
• Technical factors influence ICGA fluorescence and interpretation.

Purpose of the Study:

• Evaluate technical factors affecting ICGA fluorescence intensity.
• Determine optimal timing for ICGA assessment in breast reconstruction.
• Correlate ICGA perfusion values with postoperative flap outcomes.

Main Methods:

• Retrospective study of 260 immediate implant-based breast reconstructions (2015-2021).
• Standardized ICGA technique with controlled ambient lighting, camera distance, and ICG dose.
• Analysis of "time to perfusion" (30, 60, 90 seconds) and "absolute"/"relative" perfusion values.

Main Results:

• A 3.1% rate of mastectomy skin flap necrosis was observed.
• Lower ICGA perfusion values at 60 and 90 seconds predicted necrosis (AUC 0.84-0.85).
• Fluorescence intensity positively correlated with "time to perfusion" (r=0.9, P<0.001) in non-necrotic flaps.

Conclusions:

• A standardized ICGA protocol is recommended for reliable perfusion analysis.
• Assessment at ≤30 seconds is insufficient for accurate perfusion evaluation.
• Utilizing 60 or 90-second perfusion recordings optimizes necrosis prediction reliability.