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A Comparison of Methods for Assessing Mastectomy Flap Viability in Skin-Sparing Mastectomy and Immediate Reconstruction: A Prospective Cohort Study
Brian Rinker, M.D..
University of Kentucky, Lexington, KY, USA.

PURPOSE: Three methods of assessing mastectomy flap viability following skin-sparing mastectomy (SSM) and immediate reconstruction were compared to determine which is the most effective in reducing mastectomy flap necrosis (MFN).
METHODS: The study group consisted of 60 consecutive patients (99 breasts) undergoing SSM and immediate reconstruction with either tissue expanders (n=39) or TRAM flaps (n=21). Mastectomy flap viability was assessed either visually (n=20), with intravenous fluorescein dye and Wood’s lamp imaging (n=20), or indocyanine green (ICG) angiography (n=20). Variation across groups was analyzed using ANOVA for continuous variables and chi-square test for dichotomous variables.
RESULTS: Mean follow up was 10 months. The groups did not show significant differences in mean age, BMI, medical history, smoking history, pathologic diagnosis, chemotherapy, or reconstruction type. MFN was observed in 8 of 30 breasts in the direct visualization group (27%), compared to 14% in the ICG angiography group, and 3% in the fluorescein group (p=0.03). Reoperation rate in the direct visualization group was 20%, compared to 15% in the ICG angiography group, and 0% in the fluorescein group.
CONCLUSION: ICG angiography was associated with a reduced rate of MFN compared to direct visualization, but fluorescein dye was associated with the lowest complication rates. Routine imaging of mastectomy flap perfustion seems to be beneficial in SSM, but intravenous fluorescein may be as effective as more expensive modalities.
Direct
Visualization
Fluoroscein
/ Wood’s Lamp
ICG
Angiography
P-value
No. of Patients202020
Age, mean y (SD)50.4 (7.6)50.5 (11.4)47.2 (7.7).432
BMI, mean kg/m2 (SD)31.4 (9.4)28.6 (6.0)32.2 (6.3).282
Breasts w/ MFN8 (27%)1 (3%)5 (14%).025
Reoperation, %20015.122
Seroma,%51025.153
Infection, %15520.364




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