USE OF LASER-ASSISTED INDOCYANIN GREEN ANGIOGRAPHYIN BREASTRECONSTRUCTION: SYSTEMATIC REVIEW AND METHANALYSIS

Introduction: Nowadays breast reconstruction has changed greatly as skin-saving mastectomies and adenomastectomies have been shown to be oncologically safe, allowing better aesthetic results. Skin perfusion and the areola-papillary complex (APC) perfusion is fundamental to the success of reconstruction, whether prosthetic orflapped.Failure to detectperfusion problems may culminate postoperatively in necrosis, infection, loss of prostheses, and reoperations. Currently, several protocols have been used and published validating laser-assisted indocyanine green angiography (IGA) as a method for detecting intraoperative perfusion, but there is a lack of statistically relevant data in the literature to justify its use and validate it as a safe method. Objective: The aim of the study is to perform a meta-analysis on the use of IGA assessing necrosis, infection, reoperation and seroma rates of post mastectomy reconstruction procedures compared to clinical evaluation, verifying if its use prevents complications and improves outcomes on breast reconstruction. Methodology: Two authors searched in the MEDLINE (Pubmed), Google Scholar and LILACS databases for articles published until June 2019. The descriptors “indocianyne green” and “breast reconstruction” were used. Only longitudinal studies that compared the clinical evaluation with the use of IGA in the evaluation of skin flaps and APC were included. A meta-analysis was performed for random effects, having as outcomes the complications analyzed: necrosis, infection, seroma and need for reoperation. Results: Ten studies reporting the use of IGA in breast reconstruction met the inclusion criteria (n: 2256). The occurrence of necrosis was 2.06x higher in the control group (clinical evaluation) with statistical relevance (p: 0.00060), 95% CI (1.36 - 3.11). Reoperations for any complication were statistically relevant, with a risk of 2.05x in the control group relative to the IGA group (p: 0.0002), 95% CI (1.413.0). Infection was higher in the control group (OR: 1.78, 95% CI, 1.00-3.17) but without statistical significance (p: 0.05). Seroma showed no divergence between groups (OR: 1.06, 95% CI, 0.60-1.86, p: 0.85). Conclusion: The use of laser-assisted IGA prevents necrotic events and the need for surgical re-intervention. The study also suggests benefit of using it to prevent infection.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
23 October 2019