Paloma Malagón-López1, Cristian Carrasco-López2, Oihane García-Senosiain2, Jordi Vilà2, María Del-Río2, David Priego2, Juan F Julian-Ibáñez3, Carmen Higueras-Suñe4. 1. Department of Plastic Surgery, Hospital Germans Trias i Pujol, Universitat Autonoma de Barcelona, Barcelona, Spain. Electronic address: pal.malagon@gmail.com. 2. Department of Plastic Surgery, Hospital Germans Trias i Pujol, Barcelona, Spain. 3. Chief and Professor of General Surgery Department, Hospital Germans Trias i Pujol, Universitat Autonoma de Barcelona, Barcelona, Spain. 4. Chief of Plastic Surgery Department, Hospital Germans Trias i Pujol, Barcelona, Spain.
Abstract
BACKGROUND: Although the indocyanine green angiography (ICGA) has been used for years in the assessment of Deep Inferior Epigastric Perforator (DIEP) perfusion, it has not yet been established when it should be performed during the surgery. The aim of this study is to evaluate whether it is better to perform the test on the donor or recipient sites. METHODS: Intraoperative perfusion of 46 DIEP flaps was assessed twice, on the donor and recipient sites. Differences between both ischemic areas of each flap were statistically analyzed. In addition, perforator location and risk factors were evaluated in order to assess whether they are associated with changes in the perfusion of the flap between both sites. RESULTS: Differences between ischemic areas on the donor and recipient sites were statistically significant (p = 0.012). However, in most cases (82.6%) the ischemic area was the same on both sites, and the final flap design only changed in two cases (4.3%) because of the ICGA findings on the recipient site. Besides, performing the ICGA on the donor site facilitated the identification of the best perfused areas, allowed a better planning of its placement into the recipient site, and also can be useful to choose the best perforator. Bilateral DIEP flap, lateral location of the perforator and tobacco use had a statistically significant association with lower probability to increase the perfusion area between both sites. CONCLUSIONS: several advantages have been found in performing the ICGA on the donor site to assess the perfusion of the DIEP flap.
BACKGROUND: Although the indocyanine green angiography (ICGA) has been used for years in the assessment of Deep Inferior Epigastric Perforator (DIEP) perfusion, it has not yet been established when it should be performed during the surgery. The aim of this study is to evaluate whether it is better to perform the test on the donor or recipient sites. METHODS: Intraoperative perfusion of 46 DIEP flaps was assessed twice, on the donor and recipient sites. Differences between both ischemic areas of each flap were statistically analyzed. In addition, perforator location and risk factors were evaluated in order to assess whether they are associated with changes in the perfusion of the flap between both sites. RESULTS: Differences between ischemic areas on the donor and recipient sites were statistically significant (p = 0.012). However, in most cases (82.6%) the ischemic area was the same on both sites, and the final flap design only changed in two cases (4.3%) because of the ICGA findings on the recipient site. Besides, performing the ICGA on the donor site facilitated the identification of the best perfused areas, allowed a better planning of its placement into the recipient site, and also can be useful to choose the best perforator. Bilateral DIEP flap, lateral location of the perforator and tobacco use had a statistically significant association with lower probability to increase the perfusion area between both sites. CONCLUSIONS: several advantages have been found in performing the ICGA on the donor site to assess the perfusion of the DIEP flap.
Authors: Fernando Dip; Luigi Boni; Michael Bouvet; Thomas Carus; Michele Diana; Jorge Falco; Geoffrey C Gurtner; Takeaki Ishizawa; Norihiro Kokudo; Emanuele Lo Menzo; Philip S Low; Jaume Masia; Derek Muehrcke; Francis A Papay; Carlo Pulitano; Sylke Schneider-Koraith; Danny Sherwinter; Giuseppe Spinoglio; Laurents Stassen; Yasuteru Urano; Alexander Vahrmeijer; Eric Vibert; Jason Warram; Steven D Wexner; Kevin White; Raul J Rosenthal Journal: Ann Surg Date: 2022-04-01 Impact factor: 13.787