Practicing changing cases using ICG technology in Breast Reconstruction
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2017, Vol 1, Issue 5
Abstract
SPY Elite technology utilizes ICG angiography and is a method of intra-operative tissue perfusion assessment. In breast reconstructive surgery, knowledge of skin flap perfusion can assist intra-operative decision making. Altering the surgical plan accordingly can decrease the risk of ischemic complications. The current case series includes six mastectomy and complex reconstructive operative cases that utilized SPY Elite technology. The cases demonstrate how SPY Elite assessment led to changes in intra-operative decision making in a group of predominantly high risk patients. This case series demonstrates how intraoperative SPY Elite (Novadaq Technologies Inc., Mississauga, Ontario, Canada) (SPY) assessment of skin flaps can influence decision-making in direct to implant (DTI) and expander-based reconstruction. One of the operative concerns with nipple and skin sparing mastectomy patterns is the perfusion of the remaining skin following removal of the vascular inflow from the breast [1,2]. Ischemic complications, particularly necrosis, can lead to failure of reconstruction, which in turn may require further surgical revision and result in delays to adjuvant therapies [3-5]. Additionally, skin complications may negatively impact the aesthetic result of the reconstruction [3,5]. The technique by which implant based reconstruction is performed has evolved to include the use of cellular dermal matrixes (ADM) to support the lower pole of the implant. The popularity of ADMs is predominantly due their ability to allow lower pole coverage in DTI reconstruction without donor site morbidity and allow for better filling of the breast envelope when expanders are used [6]. For an ADM to work it needs to integrate with the skin, which requires adequate blood flow [7]? The SPY Elite system allows for real time assessment of the skin flap perfusion post mastectomy. Knowledge of low perfusion areas within the skin can assist the surgeon in deciding the safest surgical approach for that patient. The purpose of this case series is to demonstrate examples of how SPY technology has led to specific changes in decision making in complicated and high-risk reconstructive cases.
Authors and Affiliations
Atara Posner, Farhad Azimi, David Goltsman, Sanjay Warrier
Keywords
Related Articles
- EP ID EP573640
- DOI 10.26717/BJSTR.2017.01.000432
- Views 157
- Downloads 0
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