Intraoperative Umbilical Perfusion Assessment Following Deep Inferior Epigastric Perforator Breast Reconstruction...

Prevention of wound complications of the neoumbilicus in deep inferior epigastric perforator breast reconstruction increases patient cosmetic satisfaction. The reported incidence of umbilical wound complications is between 3% and 18% in the current literature, necessitating improved prediction of such complications.

The authors evaluated a retrospective cohort of 30 consecutive patients who underwent deep inferior epigastric perforator breast reconstruction during a 1.5-year period at the University Health Network by a single surgeon. Umbilical perfusion was intraoperatively measured by the SPY quantification of perfusion (QP) system with indocyanine green angiography. Postoperative outcomes were assessed in the outpatient clinic and classified as no wound complication, minor wound dehiscence, partial, or total necrosis.

A total of 30 patients were included: 19 with no complications, 2 had minor wounds, 3 had dehiscence, 3 had partial necrosis, and 3 had total necrosis. The average patient age was 50 ± 10 years; the average body mass index was 28 ± 4 kg/m². Seven (23%) patients had a smoking history, and 1 (3%) patient was an active smoker. Patients with an average SPY-QP of 66% or higher had no umbilical wound complications. An average SPY-QP of 31% or lower predicts minor wound complications, 26% or lower predicts partial or total necrosis, and 13% or lower predicts total necrosis.

Intraoperative indocyanine green angiography is an excellent adjunct to clinical assessment for predicting umbilical wound complications. A surgeon can use SPY-QP to make intraoperative decisions to improve outcomes if quantitative perfusion is poor.