Intraoperative Perfusion Techniques Can Accurately Predict Mastectomy Skin Flap Necrosis in Breast Reconstruction: Results of a Prospective Trial
Intraoperative Perfusion Techniques Can Accurately Predict Mastectomy Skin Flap Necrosis in Breast Reconstruction: Results of a Prospective Trial
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DOI：
10.1097/prs.0b013e31824a2ae8
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发表时间：
2012-05-01
影响因子：
3.6
通讯作者：
Bui, Duc T.
中科院分区：
文献类型：
--
作者：
Phillips, Brett T.;Lanier, Steven T.;Bui, Duc T.
背景：术中血管成像有助于评估乳房切除皮瓣灌注情况，以预测坏死区域。尚无头对头研究将激光辅助吲哚菁绿染料血管造影和荧光素染料血管造影等方法与临床评估进行比较。
方法：作者进行了一项组织扩张器 - 植入物乳房重建的前瞻性临床试验，术中通过临床评估、激光辅助吲哚菁绿染料血管造影和荧光素染料血管造影对乳房切除皮瓣进行评估。对术中预测的坏死区域进行拍照记录，临床评估指导切除。将术后坏死情况与各项预测结果直接进行比较。主要观察指标是全层皮肤坏死。
结果：完成了51例组织扩张器 - 植入物乳房重建手术（32例患者），其中21例出现全层坏死（41.2%）。在临床判断失误的21例病例中，激光辅助吲哚菁绿染料血管造影和荧光素染料血管造影正确预测了19例坏死。21例中仅有6例为全层坏死，21例中有5例需要干预（9.8%）。吸烟、肥胖和乳房重量大于1000克等风险因素具有统计学意义。激光辅助吲哚菁绿染料血管造影和荧光素染料血管造影对坏死区域的高估比例分别为72%和88%（p = 0.002）。对坏死区域的激光辅助吲哚菁绿染料血管造影定量分析显示，绝对灌注单位小于3.7，敏感度为90%，特异度为100%。
结论：激光辅助吲哚菁绿染料血管造影比荧光素染料血管造影和临床判断更能预测乳房切除皮瓣坏死。在没有定量分析的情况下，两种方法都会高估。激光辅助吲哚菁绿染料血管造影更具特异性，且与坏死的标准诊断相关性更好。（《整形与重建外科》2012年；129卷：778e）
Background: Intraoperative vascular imaging can assist assessment of mastectomy skin flap perfusion to predict areas of necrosis. No head-to-head study has compared modalities such as laser-assisted indocyanine green dye angiography and fluorescein dye angiography with clinical assessment.Methods: The authors conducted a prospective clinical trial of tissue expander-implant breast reconstruction with intraoperative evaluation of mastectomy skin flaps by clinical assessment, laser-assisted indocyanine green dye angiography, and fluorescein dye angiography. Intraoperatively predicted regions of necrosis were photographically documented, and clinical assessment guided excision. Postoperative necrosis was directly compared with each prediction. The primary outcome was all-inclusive skin necrosis.Results: Fifty-one tissue expander-implant breast reconstructions (32 patients) were completed, with 21 cases of all-inclusive necrosis (41.2 percent). Laser-assisted indocyanine green dye angiography and fluorescein dye angiography correctly predicted necrosis in 19 of 21 of cases where clinical judgment had failed. Only six of 21 cases were full-thickness necrosis, and five of 21 required an intervention (9.8 percent). Risk factors such as smoking, obesity, and breast weight greater than 1000 g were statistically significant. Laser-assisted indocyanine green dye angiography and fluorescein dye angiography overpredicted areas of necrosis by 72 percent and 88 percent (p = 0.002). Quantitative analysis for laser-assisted indocyanine green dye angiography in necrotic regions showed absolute perfusion units less than 3.7, with 90 percent sensitivity and 100 percent specificity.Conclusions: Laser-assisted indocyanine green dye angiography is a better predictor of mastectomy skin flap necrosis than fluorescein dye angiography and clinical judgment. Both methods overpredict without quantitative analysis. Laser-assisted indocyanine green dye angiography is more specific and correlates better with the criterion standard diagnosis of necrosis. (Plast. Reconstr. Surg. 129: 778e, 2012.)