The intraoperative application of indocyanine green (ICG), in breast reconstructive surgery using a latissimus dorsi flap, as a preventive factor for tissue ischemia and postoperative complications

Abstract

Introduction: Breast cancer is the most frequent cancer among women. Nowadays more and more women decide to undergo breast reconstruction, both using implants as well as autologous flaps. The most important factor in avoiding bad wound healing is the preservation of blood supply and good tissue perfusion. Latissimus dorsi flap is a commonly used method, mainly reserved for irradiated patients, delayed reconstruction, or salvage procedures. With damaged tissues, objectively assessing the conditions is much more difficult than in primary surgery.Aim: The aim of the study is to present the intraoperative application of ICG, in breast reconstructive surgery with a latissimus dorsi flap, as a preventive factor for tissue ischemia and postoperative complications. Materials and methods: A single-center retrospective review of the outcomes of 12 patients who underwent breast reconstruction using an LD flap, with an intraoperative assessment of flap blood supply using ICG. Patient characteristics, comorbidities, and smoking were taken into account. Results: In two cases, after an initial assessment of tissue perfusion, it was decided to resection the distal part of the flap with less blood supply. All reconstructions were successful and the wounds healed properly. None of the patients required reoperation, there were no postoperative complications or surgical site infections.Conclusion: The use of ICG in breast reconstruction with an LD flap is an important predictor of postoperative complications, especially flap necrosis and loss of reconstruction.