吲哚菁绿血管造影在腹部皮瓣乳房再造中的应用

Experince of ICGA-guided breast reconstruction with abdominal flap

目的探讨应用腹部皮瓣进行乳房再造术中吲哚菁绿血管造影的应用价值，进一步减少腹部皮瓣乳房再造并发症的发生。方法回顾性分析术中采用吗哚菁绿血管造影指导腹部皮瓣乳房再造的2l例患者临床资料，其中双蒂DIEP皮瓣7例，带蒂TRAM和对侧游离TRAM皮瓣5例，带蒂TRAM和对侧DIEP皮瓣4例，单侧DIEP皮瓣3例，单蒂TRAM皮瓣2例。根据再造的方式不同，术中分别于皮瓣切取后、血管吻合后进行吲哚菁绿血管造影，评价皮瓣的血运以及吻合血管的通畅情况。结果术中共进行吲哚菁绿血管造影52次，未出现造影相关并发症。其中6例根据术中吲哚菁绿造影结果调整手术方案，包括2例（1例TRAM皮瓣和1例DIEP皮瓣）去除皮瓣远端血供不良的部分，2例皮瓣加用对侧游离血管吻合保证皮瓣血供，术中吻合血管造影发现血管阻塞1例，血管血栓形成1例，及时予以处理。术后随访3-30个月，中位时间16个月，术后未发生血管危象，皮瓣全部成活，未出现皮瓣部分或全部坏死、伤口感染等并发症。结论采用腹部皮瓣进行乳房再造时，术中吲哚菁绿血管造影能够实时评价皮瓣血供和血管通畅情况，从而保证乳房再造的成功。

Objective This article provides an overview of our experience using indocyanine green angiography （ICGA） in breast reconstruction with abdominal flap to ascertain the application value of ICGA and its usage in decreasing postoperative complications. Methods A total of 21 breast reconstructions with intraoperative ICGA were analyzed retrospectively, including 7 bilateral deep inferior epigastric perforator （DIEP） flaps, 5 pedicled transverse rectus abdominis myocutaneous （TRAM） flaps with contralateral free TRAM flaps, 4 pedicled TRAM flaps with contralateral DIEP flaps, 3 unilateral DIEP flaps and 2 unilateral pedicled TRAM flaps. According to different breast reconstruction methods, ICGA were applied respectively after flap harvesting and vessel anastomosis, in order to evaluate the blood supply of flaps and vessel perfusion. Results A total of 52 ICGA were performed and recorded intraoperatively without any indocyanine green-associated complications. The operation methods were modified according to ICGA findings in 6 of 21 cases. The distal part of flaps were discarded due to poor perfusion in 2 cases （ 1 DIEP flap and 1 TRAM flap） , additional free vessel anastomosis were needed in 2 cases to ensure sufficient blood supply, 2 vascular complication including 1 vascular occlusion and I vascular thrombosis were found and managed in time. During the follow-up （range from 3 to 30 months, median of 16 months） , no vascular crisis was reported. All flaps survived satisfactorily without partial or whole flap necrosis or wound infection. Conclusions Intraoperative ICGA can provide real-time information of flap＇s blood supply and vessel perfusion to evaluate the conditions of flaps and vascular anastomosis, which can help surgeons take actions accordingly to increase the successful rate of breast reconstruction.