RESUMEN
INTRODUCTION: The use of allotransplants for breast reconstruction in surgical stage of the the breast cancer treatment requires tissue perfusion control. The aim of the study was to analyze the effectiveness of using indocyanine green as a drug for determining the perfusion of perforant flaps in breast reconstructive surgery. MATERIAL AND METHODS: A retrospective series of observations of 27 breast reconstructions using autologous transplants is presented: 19 reconstructions with DIEP-flap, 2 with SIEA-flap, 5 with TD-flap; 1 with thoracoepigastric flap. Intraoperative fluorescence angiography was performed using a Stryker device (5900 Optical Court, USA). The intensity of the flap fluorescence was recorded after intravenous bolus injection of 7.5 mg indocyanine green. RESULTS AND DISCUSSION: The optimal time interval from the moment of drug administration to indicative visualization of flap perfusion was 55-60 seconds. In all patients, the area of insufficient blood flow was excised within intensively blood-supplied tissues, according to mapping data with the indocyanine green. With free transplant of flaps postoperative complications during follow-up were recorded in 1 (4.8%) case (marginal necrosis), which is associated with insufficient compression of auxiliary vessels (violation of the dominant vessel contrast technique). With non-free transplant of flaps no complications were detected in the postoperative period. CONCLUSIONS: Indocyanine green allows to prevent necrotic changes and reduce the rehabilitation period. The optimal time for the indicative visualization of flap perfusion was 55-60 seconds. The use of indocyanine green in free transplant of flaps ensured a postoperative period without complications in 20 (95.2%) cases, in non-free flap transplantation - in 6 (100%) cases.
Asunto(s)
Neoplasias de la Mama , Verde de Indocianina , Mamoplastia , Colgajo Perforante , Humanos , Verde de Indocianina/administración & dosificación , Femenino , Mamoplastia/métodos , Mamoplastia/efectos adversos , Colgajo Perforante/irrigación sanguínea , Persona de Mediana Edad , Neoplasias de la Mama/cirugía , Estudios Retrospectivos , Adulto , Angiografía con Fluoresceína/métodos , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/diagnóstico , Colorantes/administración & dosificación , Mastectomía/métodos , Mastectomía/efectos adversosRESUMEN
OBJECTIVE: To analyze the efficacy of sentinel lymph node detection using indocyanine green (ICG) in breast cancer. MATERIAL AND METHODS: The study included 153 breast cancer patients (stage 0-I-II-III, cN0 or cN1-ycN0) between October 2022 and April 2023. All patients underwent sentinel lymph node biopsy using ICG. RESULTS: Sentinel lymph node was successfully detected in 150 cases out of 153 ICG injections. Optimal period between ICG injection and its accumulation in regional lymph nodes was 10-12 min. Sensitivity of sentinel lymph node detection was 98.0% that exceeds the approximate value of radioisotope method adopted as a standard (96.9-97.2%), as well as sensitivity of proprietary blue dye (90.6-95.0%). Specificity of this method was 100%. CONCLUSION: The authors' experience regarding application of indocyanine green is consistent with numerous world statistics and proves the possibility of its effective use for sentinel lymph node biopsy. It is necessary to introduce this diagnostic method as a leading or alternative method for analysis of sentinel lymph node in national clinical guidelines.