How Should Indocyanine Green Dye Angiography be Assessed to Best Predict Mastectomy Skin Flap Necrosis? A systematic review

How Should Indocyanine Green Dye Angiography be Assessed to Best Predict Mastectomy Skin Flap Necrosis? A systematic review:



Publication date: Available online 18 February 2020

Source: Journal of Plastic, Reconstructive & Aesthetic Surgery

Author(s): Caroline Driessen, Tinna Harper Arnardóttir, Andres Rodriguez Lorenzo, Maria Rydevik Mani

Abstract

Introduction

The incidence of skin flap necrosis after mastectomies is as high as 11-24%. Laser-assisted indocyanine green (ICG) angiography seems to be a promising technique to assess skin flap perfusion. The aim of this systematic review is to assess the current methodology of ICG and its objective outcome measures ability to predict mastectomy skin flap necrosis.

Methods

A PubMed search was conducted on the 31st of December 2018 using ((("Fluorescein Angiography"[Mesh]) OR ("Indocyanine Green"[Mesh])) AND "Mastectomy"[Mesh]). This systematic review was performed in accordance with the PRISMA guidelines. We included data about the study size, study design, skin flap necrosis, camera details and the objective outcome parameters.

Results

Of 51 results, 22 abstracts were considered relevant of which nine were excluded secondarily. A reference check resulted in three extra inclusions. Sixteen papers were reviewed focussing on their methods and our primary endpoint which was the objective outcome measures of ICG. Objective outcome measures were reported in eight of sixteen studies. They mainly include absolute perfusion units and relative perfusion units. All studies revealed a substantial decrease in skin necrosis when the ICG was used. The absolute number of units considered to be predictive for necrosis vary greatly; relative perfusion units have been quite well established and are considered to be predictive for necrosis between 15.6% and 41.6%. However, consensus for methods, numbers and parameters is lacking.

Conclusion

ICG evaluation of skin perfusion is a promising technique to aid in the surgeon's decision making, and seems to decrease skin flap necrosis after mastectomy.