Assessment of deep inferior epigastric perforator flap perfusion with near-infrared fluorescence: A pilot study and description of a standardized working protocol
Fat necrosis (FN) is a common complication after autologous breast reconstruction (ABR) using a free flap, which can influence reconstruction outcome and patient satisfaction. Intraoperative near-infrared fluorescence imaging using indocyanine green (ICG) permits the visualization of flap perfusion....
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Veröffentlicht in: | Journal of plastic, reconstructive & aesthetic surgery reconstructive & aesthetic surgery, 2022-03, Vol.75 (3), p.1171-1178 |
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creator | Michi, Marlies Verduijn, Pieter S. Corion, Leonard U.M. Vahrmeijer, Alexander L. Mulder, Babs G. Sibinga |
description | Fat necrosis (FN) is a common complication after autologous breast reconstruction (ABR) using a free flap, which can influence reconstruction outcome and patient satisfaction. Intraoperative near-infrared fluorescence imaging using indocyanine green (ICG) permits the visualization of flap perfusion. The aim of this study was to assess the effect of near-infrared fluorescence on FN incidence in patients undergoing an ABR with a deep inferior epigastric perforator flap (DIEP) and to propose a standard working protocol for this technique.
In this prospective study, patients undergoing one-sided ABR with a DIEP were included. The standard DIEP procedure was complemented with near-infrared fluorescence imaging using the fluorescent tracer ICG to evaluate flap perfusion. This cohort was compared to a retrospective cohort of DIEP procedures without near-infrared fluorescence imaging. Patients and surgery characteristics, as well as postoperative complications, were registered and compared.
In both cohorts, 24 patients were included. No significant differences were present between patients and surgery characteristics, including no difference in duration of surgery. In the prospective and retrospective group, the incidence of FN was 4.2% and 33%, respectively (p-value = 0.023). Moreover, microsurgeons were positive about using near-infrared fluorescence as it either provided additional information about perfusion or confirmed the clinical assessment.
Our pilot study showed a significant decrease of FN in patients undergoing an ABR with a DIEP when near-infrared fluorescence imaging was used to assess flap perfusion. This study provides a standardized working protocol for near-infrared fluorescence imaging. In the future, large multicenter studies should focus on the quantification of near-infrared fluorescence imaging. |
doi_str_mv | 10.1016/j.bjps.2021.11.043 |
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In this prospective study, patients undergoing one-sided ABR with a DIEP were included. The standard DIEP procedure was complemented with near-infrared fluorescence imaging using the fluorescent tracer ICG to evaluate flap perfusion. This cohort was compared to a retrospective cohort of DIEP procedures without near-infrared fluorescence imaging. Patients and surgery characteristics, as well as postoperative complications, were registered and compared.
In both cohorts, 24 patients were included. No significant differences were present between patients and surgery characteristics, including no difference in duration of surgery. In the prospective and retrospective group, the incidence of FN was 4.2% and 33%, respectively (p-value = 0.023). Moreover, microsurgeons were positive about using near-infrared fluorescence as it either provided additional information about perfusion or confirmed the clinical assessment.
Our pilot study showed a significant decrease of FN in patients undergoing an ABR with a DIEP when near-infrared fluorescence imaging was used to assess flap perfusion. This study provides a standardized working protocol for near-infrared fluorescence imaging. In the future, large multicenter studies should focus on the quantification of near-infrared fluorescence imaging.</description><identifier>ISSN: 1748-6815</identifier><identifier>EISSN: 1878-0539</identifier><identifier>DOI: 10.1016/j.bjps.2021.11.043</identifier><identifier>PMID: 34924327</identifier><language>eng</language><publisher>Netherlands: Elsevier Ltd</publisher><subject>Autologous breast reconstruction ; Deep inferior epigastric artery perforator (DIEP) flap ; Fat necrosis ; Fluorescence imaging ; Free flap ; Perfusion assessment</subject><ispartof>Journal of plastic, reconstructive & aesthetic surgery, 2022-03, Vol.75 (3), p.1171-1178</ispartof><rights>2021 British Association of Plastic, Reconstructive and Aesthetic Surgeons</rights><rights>Copyright © 2021 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c400t-5ab7e3e393bd22578d71cf3694bdbe04b696e67379a65cda29dbb016e29655783</citedby><cites>FETCH-LOGICAL-c400t-5ab7e3e393bd22578d71cf3694bdbe04b696e67379a65cda29dbb016e29655783</cites><orcidid>0000-0001-9327-2520</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.bjps.2021.11.043$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34924327$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Michi, Marlies</creatorcontrib><creatorcontrib>Verduijn, Pieter S.</creatorcontrib><creatorcontrib>Corion, Leonard U.M.</creatorcontrib><creatorcontrib>Vahrmeijer, Alexander L.</creatorcontrib><creatorcontrib>Mulder, Babs G. Sibinga</creatorcontrib><title>Assessment of deep inferior epigastric perforator flap perfusion with near-infrared fluorescence: A pilot study and description of a standardized working protocol</title><title>Journal of plastic, reconstructive & aesthetic surgery</title><addtitle>J Plast Reconstr Aesthet Surg</addtitle><description>Fat necrosis (FN) is a common complication after autologous breast reconstruction (ABR) using a free flap, which can influence reconstruction outcome and patient satisfaction. Intraoperative near-infrared fluorescence imaging using indocyanine green (ICG) permits the visualization of flap perfusion. The aim of this study was to assess the effect of near-infrared fluorescence on FN incidence in patients undergoing an ABR with a deep inferior epigastric perforator flap (DIEP) and to propose a standard working protocol for this technique.
In this prospective study, patients undergoing one-sided ABR with a DIEP were included. The standard DIEP procedure was complemented with near-infrared fluorescence imaging using the fluorescent tracer ICG to evaluate flap perfusion. This cohort was compared to a retrospective cohort of DIEP procedures without near-infrared fluorescence imaging. Patients and surgery characteristics, as well as postoperative complications, were registered and compared.
In both cohorts, 24 patients were included. No significant differences were present between patients and surgery characteristics, including no difference in duration of surgery. In the prospective and retrospective group, the incidence of FN was 4.2% and 33%, respectively (p-value = 0.023). Moreover, microsurgeons were positive about using near-infrared fluorescence as it either provided additional information about perfusion or confirmed the clinical assessment.
Our pilot study showed a significant decrease of FN in patients undergoing an ABR with a DIEP when near-infrared fluorescence imaging was used to assess flap perfusion. This study provides a standardized working protocol for near-infrared fluorescence imaging. In the future, large multicenter studies should focus on the quantification of near-infrared fluorescence imaging.</description><subject>Autologous breast reconstruction</subject><subject>Deep inferior epigastric artery perforator (DIEP) flap</subject><subject>Fat necrosis</subject><subject>Fluorescence imaging</subject><subject>Free flap</subject><subject>Perfusion assessment</subject><issn>1748-6815</issn><issn>1878-0539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNp9kctu1TAQhiMEojdegAXykk2CL7kiNkcVFKRKbNq15cuk-JATh7FDVR6HJ-2EU1iysT3j75_RzF8UrwWvBBftu31l90uqJJeiEqLitXpWnIq-60veqOE5vbu6L9teNCfFWUp7ToSom5fFiaoHWSvZnRa_dylBSgeYM4sj8wALC_MIGCIyWMKdSRmDYwvgGNFkyo6TWf7EawpxZvchf2MzGCxJhwbBE7FGhORgdvCe7dgSpphZyqt_YGb21CU5DEve5NTU0BelDfrwi9T3Eb-H-Y4tGHN0cbooXoxmSvDq6T4vbj99vLn8XF5_vfpyubsuXc15LhtjO1CgBmW9lE3X-064UbVDbb0FXtt2aKHtVDeYtnHeyMFbS2sEObQN4eq8eHusS41_rJCyPgSaYZrMDHFNWrZC8nqgk1B5RB3GlBBGvWA4GHzQguvNG73Xmzd680YLoWnzJHrzVH-1B_D_JH_NIODDEQCa8mcA1MmFbYc-ILisfQz_q_8IQFSkgQ</recordid><startdate>202203</startdate><enddate>202203</enddate><creator>Michi, Marlies</creator><creator>Verduijn, Pieter S.</creator><creator>Corion, Leonard U.M.</creator><creator>Vahrmeijer, Alexander L.</creator><creator>Mulder, Babs G. Sibinga</creator><general>Elsevier Ltd</general><scope>6I.</scope><scope>AAFTH</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-9327-2520</orcidid></search><sort><creationdate>202203</creationdate><title>Assessment of deep inferior epigastric perforator flap perfusion with near-infrared fluorescence: A pilot study and description of a standardized working protocol</title><author>Michi, Marlies ; Verduijn, Pieter S. ; Corion, Leonard U.M. ; Vahrmeijer, Alexander L. ; Mulder, Babs G. Sibinga</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c400t-5ab7e3e393bd22578d71cf3694bdbe04b696e67379a65cda29dbb016e29655783</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Autologous breast reconstruction</topic><topic>Deep inferior epigastric artery perforator (DIEP) flap</topic><topic>Fat necrosis</topic><topic>Fluorescence imaging</topic><topic>Free flap</topic><topic>Perfusion assessment</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Michi, Marlies</creatorcontrib><creatorcontrib>Verduijn, Pieter S.</creatorcontrib><creatorcontrib>Corion, Leonard U.M.</creatorcontrib><creatorcontrib>Vahrmeijer, Alexander L.</creatorcontrib><creatorcontrib>Mulder, Babs G. Sibinga</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of plastic, reconstructive & aesthetic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Michi, Marlies</au><au>Verduijn, Pieter S.</au><au>Corion, Leonard U.M.</au><au>Vahrmeijer, Alexander L.</au><au>Mulder, Babs G. Sibinga</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Assessment of deep inferior epigastric perforator flap perfusion with near-infrared fluorescence: A pilot study and description of a standardized working protocol</atitle><jtitle>Journal of plastic, reconstructive & aesthetic surgery</jtitle><addtitle>J Plast Reconstr Aesthet Surg</addtitle><date>2022-03</date><risdate>2022</risdate><volume>75</volume><issue>3</issue><spage>1171</spage><epage>1178</epage><pages>1171-1178</pages><issn>1748-6815</issn><eissn>1878-0539</eissn><abstract>Fat necrosis (FN) is a common complication after autologous breast reconstruction (ABR) using a free flap, which can influence reconstruction outcome and patient satisfaction. Intraoperative near-infrared fluorescence imaging using indocyanine green (ICG) permits the visualization of flap perfusion. The aim of this study was to assess the effect of near-infrared fluorescence on FN incidence in patients undergoing an ABR with a deep inferior epigastric perforator flap (DIEP) and to propose a standard working protocol for this technique.
In this prospective study, patients undergoing one-sided ABR with a DIEP were included. The standard DIEP procedure was complemented with near-infrared fluorescence imaging using the fluorescent tracer ICG to evaluate flap perfusion. This cohort was compared to a retrospective cohort of DIEP procedures without near-infrared fluorescence imaging. Patients and surgery characteristics, as well as postoperative complications, were registered and compared.
In both cohorts, 24 patients were included. No significant differences were present between patients and surgery characteristics, including no difference in duration of surgery. In the prospective and retrospective group, the incidence of FN was 4.2% and 33%, respectively (p-value = 0.023). Moreover, microsurgeons were positive about using near-infrared fluorescence as it either provided additional information about perfusion or confirmed the clinical assessment.
Our pilot study showed a significant decrease of FN in patients undergoing an ABR with a DIEP when near-infrared fluorescence imaging was used to assess flap perfusion. This study provides a standardized working protocol for near-infrared fluorescence imaging. In the future, large multicenter studies should focus on the quantification of near-infrared fluorescence imaging.</abstract><cop>Netherlands</cop><pub>Elsevier Ltd</pub><pmid>34924327</pmid><doi>10.1016/j.bjps.2021.11.043</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0001-9327-2520</orcidid><oa>free_for_read</oa></addata></record> |
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subjects | Autologous breast reconstruction Deep inferior epigastric artery perforator (DIEP) flap Fat necrosis Fluorescence imaging Free flap Perfusion assessment |
title | Assessment of deep inferior epigastric perforator flap perfusion with near-infrared fluorescence: A pilot study and description of a standardized working protocol |
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