Effectiveness of “Indocyanine Green Dye Clamp Test” in Selecting Perforators for Muscle-Sparing-2 Transverse Rectus Abdominis Myocutaneous Flaps in Breast Reconstruction

Seiko Okumura; Meisei Takeishi; Ryota Nakamura; Satoshi Kakutani; Ikuo Hyodo; Yuzuru Kamei

doi:10.1055/s-0037-1606360

Journal of Reconstructive Microsurgery Open, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · J Reconstr Microsurg Open 2017; 02(02): e126-e131
DOI: 10.1055/s-0037-1606360

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Effectiveness of “Indocyanine Green Dye Clamp Test” in Selecting Perforators for Muscle-Sparing-2 Transverse Rectus Abdominis Myocutaneous Flaps in Breast Reconstruction

Seiko Okumura

¹Department of Plastic and Reconstructive Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan

²Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan

,

Meisei Takeishi

³Breast Reconstruction Institute, Mishima, Japan

,

Ryota Nakamura

²Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan

,

Satoshi Kakutani

¹Department of Plastic and Reconstructive Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan

,

Ikuo Hyodo

¹Department of Plastic and Reconstructive Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan

,

Yuzuru Kamei

²Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan

› Institutsangaben

Abstract

Introduction In breast reconstruction for cases in which tissue from zones 1 to 4 is required or a lower midline scar exists, it is possible to predict the need for vascular anastomosis with a vascular pedicle on the contralateral side if the dominant territory of each perforator can be identified in advance. In addition, it is possible to determine whether a single- or multiple-perforator-based flap is needed. We, therefore, developed the “indocyanine green dye (ICG) clamp test” to select perforators for breast reconstruction.

Methods The blood flow of a perforator was blocked using a microvascular clamp when determining its inclusion in a flap. The clamps were released after the enlargement of the ICG fluorescence imaging range. The enlarged imaging range was then observed to determine whether an additional pedicle was required.

Subjects One hundred thirty-two breast reconstruction procedures had been performed using the free muscle-sparing-2 transverse rectus abdominis myocutaneous (MS2 TRAM) flap method from May 2012 to December 2015. The population of the present study included 29 of these cases in which the selection of perforators was deemed necessary.

Results We investigated the cases in which anastomosis of the contralateral vascular pedicle was unnecessary. It was possible to preserve the medial muscle in 79.3% of the cases using our procedure.

Conclusion Our newly developed ICG clamp test was useful in selecting perforators for MS2 TRAM flaps and facilitated the performance of minimally invasive surgery.

Keywords

MS2 TRAM flap - breast reconstruction - indocyanine green dye

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