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Wilson AC, Pisansky AJ, Tessier KM, Hui J, Choudry U, Lassig AAD. Use of SPY angiography in tissue assessment for wound healing outcomes after breast reconstruction. J Wound Care 2024; 33:S30-S41. [PMID: 38973640 DOI: 10.12968/jowc.2021.0377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
OBJECTIVE The objective of this study was to evaluate whether a systematic image assessment protocol using SPY Elite images (LifeCell Corp., US) of viable tissue at the periphery of the surgical field was associated with positive wound healing outcomes following mastectomy and breast reconstruction. METHOD Patients undergoing mastectomy and subsequent breast reconstruction surgery at a single tertiary medical centre were included. SPY images were prospectively analysed using a systematic image assessment protocol, and an absolute value of mean fluorescence was calculated by measuring peripheral, in-situ tissue from each image. Patient medical records were retrospectively reviewed for demographics, surgical characteristics and postoperative outcomes. These variables were statistically tested for associations with mean fluorescence. RESULTS A total of 63 patients were included in the final analysis. We found that objectively determined mean fluorescence values were not statistically significantly associated with postoperative complications. CONCLUSION In this study, objectively measured mean fluorescence values representing breast tissue remaining after dissection showed little utility in the assessment of postoperative wound healing outcomes as they did not identify patients who would later have complications of wound healing. DECLARATION OF INTEREST The authors have no conflicts of interest to declare.
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Affiliation(s)
- Anna C Wilson
- Hennepin Healthcare Research Institute, Hennepin Healthcare/Hennepin County Medical Center, Department of Otolaryngology, Minneapolis, MN, US
- University of Minnesota School of Medicine, Department of Otolaryngology - Head and Neck Surgery, Division of Head and Neck Surgery, Minneapolis, MN, US
| | - Andrew Jb Pisansky
- University of Minnesota School of Medicine, Department of Otolaryngology - Head and Neck Surgery, Division of Head and Neck Surgery, Minneapolis, MN, US
- Vanderbilt University School of Medicine, Department of Anesthesiology, Divisions of Multispecialty Anesthesia/Pain Medicine, Nashville, TN, US
| | - Katelyn M Tessier
- University of Minnesota Masonic Cancer Center, Biostatistics Core, Minneapolis, MN, US
| | - Jane Hui
- University of Minnesota School of Medicine, Department of Surgery, Division of Surgical Oncology, Minneapolis, MN, US
| | - Umar Choudry
- University of Minnesota School of Medicine, Department of Surgery, Division of Plastic and Reconstructive Surgery, Minneapolis, MN, US
| | - Amy Anne D Lassig
- Hennepin Healthcare Research Institute, Hennepin Healthcare/Hennepin County Medical Center, Department of Otolaryngology, Minneapolis, MN, US
- University of Minnesota School of Medicine, Department of Otolaryngology - Head and Neck Surgery, Division of Head and Neck Surgery, Minneapolis, MN, US
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Li H, Zhang X, Li Z, Lin Y, Mu D. Using Laser-Assisted Indocyanine Green Angiography to Assess Nipple-Areolar Complex Survival During Reduction Mammoplasty. Aesthet Surg J 2024; 44:NP149-NP158. [PMID: 37883632 DOI: 10.1093/asj/sjad327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/13/2023] [Accepted: 10/13/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND In reduction mammoplasty, preserving an appropriate skin flap is crucial to achieve a favorable postoperative appearance and prevent blood supply disorders in the nipple-areolar complex (NAC). Previous studies have indicated that a thinner or narrower flap is more favorable for breast shaping, but also increases the risk of blood supply disorders. Accessing the blood perfusion of the NAC and determining the critical threshold for NAC viability are essential aspects of reduction mammoplasty. OBJECTIVES The aim of this study was to utilize indocyanine green (ICG) angiography to assess NAC perfusion during reduction mammoplasty. It also sought to identify critical thresholds of various indicators affecting NAC survival and provide guidance for skin flap trimming. METHODS Thirty-eight patients who underwent reduction mammoplasty were included. Each patient received ICG angiography before and after skin flap trimming. Data on NAC perfusion, skin flap length, width, thickness, and other relevant indicators were collected. RESULTS Among the patients, 5 experienced NAC blood supply disorders. Multiple linear regression analysis demonstrated that the NAC blood supply had a significant correlation with the tissue thickness at the pedicle base (P < .001) and with the length-to-width ratio across the nipple (P < .05). To optimize NAC survival and achieve favorable breast shaping, cutoff points for the thickness at the pedicle base and the length-to-width ratio across the nipple of 1.15 cm and 1.71, respectively, were established. CONCLUSIONS ICG angiography provides an effective means to assess NAC blood supply and postoperative survival. The cutoff points established in this study help to predict the survival of the NAC and guide flap trimming. LEVEL OF EVIDENCE: 3
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Nguyen CL, Dayaratna N, Comerford AP, Tam SKM, Paredes SR, Easwaralingam N, Seah JL, Azimi F, Mak C, Pulitano C, Warrier SK. Cost-effectiveness of indocyanine green angiography in postmastectomy breast reconstruction. J Plast Reconstr Aesthet Surg 2022; 75:3014-3021. [PMID: 35710777 DOI: 10.1016/j.bjps.2022.04.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/19/2022] [Accepted: 04/12/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Mastectomy skin flap necrosis is a major complication of skin- or nipple-sparing mastectomy. Indocyanine green angiography (ICGA) is a novel technology that can identify flaps at risk of necrosis, but there is paucity of cost-effectiveness data particularly in the Australian context. We evaluated its cost-effectiveness in breast reconstruction surgery. METHODS Single-institution retrospective study of 295 implant-based breast reconstructions using ICGA compared with 228 reconstructions without ICGA from 2015 to 2020. Costs were calculated using Medicare item numbers and micro-costing analysis. Break-even point analysis determined the number needed to break-even. Cost-utility analysis compared probabilities of ischaemic complications and utility estimates derived from surveys of surgeons to fit into a decision model. RESULTS There were 295 breast reconstructions using ICGA with a total cost of AU$164,657. The average cost of treating an ischaemic complication was AU$21,375. Use of ICGA reduced the ischaemic complication rate from 14.9% to 8.8%. Ischaemic complications were prevented in 18 breasts resulting in gross cost savings of AU$384,745 and net savings of AU$220,088. Three hundred eighteen cases using ICGA are needed to break-even. The decision model demonstrated a baseline cost difference of AU$1,179, a quality-adjusted life-years (QALY) difference of 1.77, and an incremental cost-utility ratio (ICUR) of AU$656 per QALY favouring ICGA. CONCLUSIONS Routine use of ICGA during implant-based breast reconstruction is a cost-effective intervention for the reduction of ischaemic complications in the Australian setting. ICGA use was associated with a gain of 1.77 additional years of perfect health at a cost of AU$656 more per year.
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Affiliation(s)
- Chu Luan Nguyen
- Department of Breast Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Rd, Camperdown, NSW 2050, Australia; Department of General Surgery, Royal Prince Alfred Hospital, 50 Missenden Rd, Camperdown, NSW 2050, Australia; Department of Surgery, The University of Sydney, Camperdown, NSW 2050, Australia.
| | - Nirmal Dayaratna
- Department of Surgery, The University of Sydney, Camperdown, NSW 2050, Australia
| | | | - Sze Ki Melanie Tam
- Department of Surgery, The University of Sydney, Camperdown, NSW 2050, Australia
| | - Steven Ronald Paredes
- Department of Breast Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Rd, Camperdown, NSW 2050, Australia; Department of General Surgery, Royal Prince Alfred Hospital, 50 Missenden Rd, Camperdown, NSW 2050, Australia; Department of Surgery, The University of Sydney, Camperdown, NSW 2050, Australia
| | - Neshanth Easwaralingam
- Department of Breast Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Rd, Camperdown, NSW 2050, Australia; Department of General Surgery, Royal Prince Alfred Hospital, 50 Missenden Rd, Camperdown, NSW 2050, Australia
| | - Jue Li Seah
- Department of Breast Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Rd, Camperdown, NSW 2050, Australia
| | - Farhad Azimi
- Department of Breast Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Rd, Camperdown, NSW 2050, Australia; Department of General Surgery, Royal Prince Alfred Hospital, 50 Missenden Rd, Camperdown, NSW 2050, Australia
| | - Cindy Mak
- Department of Breast Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Rd, Camperdown, NSW 2050, Australia
| | - Carlo Pulitano
- Department of General Surgery, Royal Prince Alfred Hospital, 50 Missenden Rd, Camperdown, NSW 2050, Australia; Department of Surgery, The University of Sydney, Camperdown, NSW 2050, Australia
| | - Sanjay Kumar Warrier
- Department of Breast Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Rd, Camperdown, NSW 2050, Australia; Department of Surgery, The University of Sydney, Camperdown, NSW 2050, Australia
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Nguyen CL, Barry N, Lindsay A, Seah JL, Easwaralingam N, Pulitano C, Warrier S. Indocyanine green angiography in breast reconstruction surgery: A systematic review of cost-analysis studies. J Plast Reconstr Aesthet Surg 2021; 74:3196-3211. [PMID: 34607780 DOI: 10.1016/j.bjps.2021.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/05/2021] [Accepted: 08/26/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Chu Luan Nguyen
- Department of Breast Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Rd, Camperdown NSW 2050, Australia; Department of General Surgery, Royal Prince Alfred Hospital, 50 Missenden Rd, Camperdown NSW 2050, Australia; Department of Surgery, The University of Sydney, Camperdown NSW 2050, Australia.
| | - Nick Barry
- Department of Breast Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Rd, Camperdown NSW 2050, Australia; Department of General Surgery, Royal Prince Alfred Hospital, 50 Missenden Rd, Camperdown NSW 2050, Australia
| | - Andrew Lindsay
- Department of Surgery, The University of Sydney, Camperdown NSW 2050, Australia
| | - Jue Li Seah
- Department of Breast Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Rd, Camperdown NSW 2050, Australia
| | - Neshanth Easwaralingam
- Department of Breast Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Rd, Camperdown NSW 2050, Australia; Department of General Surgery, Royal Prince Alfred Hospital, 50 Missenden Rd, Camperdown NSW 2050, Australia
| | - Carlo Pulitano
- Department of General Surgery, Royal Prince Alfred Hospital, 50 Missenden Rd, Camperdown NSW 2050, Australia; Department of Surgery, The University of Sydney, Camperdown NSW 2050, Australia
| | - Sanjay Warrier
- Department of Breast Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Rd, Camperdown NSW 2050, Australia; Department of General Surgery, Royal Prince Alfred Hospital, 50 Missenden Rd, Camperdown NSW 2050, Australia; Department of Surgery, The University of Sydney, Camperdown NSW 2050, Australia
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Lauritzen E, Damsgaard TE. Use of Indocyanine Green Angiography decreases the risk of complications in autologous- and implant-based breast reconstruction: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2021; 74:1703-1717. [PMID: 33931326 DOI: 10.1016/j.bjps.2021.03.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 03/08/2021] [Accepted: 03/13/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Indocyanine Green Angiography (ICG-A) is an imaging technique used to visualize tissue perfusion in real time. The aim of this systematic review and meta-analysis is to evaluate all published papers on breast reconstruction using ICG-A, which provides information on complication rates and to investigate whether the use of this peroperative method decreases the risk of complications. MATERIALS AND METHODS MEDLINE/PubMed, EMBASE, Cochrane, and UpToDate were searched using relevant terms. The literature was assessed using the PRISMA guidelines. Inclusion criteria were: original articles written in English assessing ICG-angiography in breast reconstruction. The individual studies were evaluated according to Cochrane guidelines. RESULTS The search yielded 243 papers on ICG-A and breast reconstruction. Twenty-six of these were included for analysis. The risk of overall major complications ([OR] = 0.53, 95% confidence interval (CI) = 0.43-0.66, p = 0.00001) and overall loss of reconstruction ([OR] = 0.58, 95% CI = 0.37-0.92, and p = 0.020) was significantly lower when peroperative ICG-A was used. When using ICG-A to evaluate mastectomy flaps, a statistically lower risk of major complications ([OR] = 0.56 and p = 0.0001) and the loss of reconstruction was found ([OR] = 0.46, p = 0.006). ICG-A used in autologous breast reconstruction significantly reduced the risk of minor ([OR] = 0.62 and p = 0.001) and major complications ([OR] = 0.53 and p = 0.0028). CONCLUSIONS This is the first systematic review to analyze the use of ICG-A on both mastectomy flaps and autologous reconstruction. The results obtained in the current study indicate that the use of ICG-A in breast reconstructive procedures reduces the complications as well as the loss of reconstruction.
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Affiliation(s)
- Elisabeth Lauritzen
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Denmark.
| | - Tine Engberg Damsgaard
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Denmark
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