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MASTEKTOMİ FLEBİ NEKROZUNU TAHMİN YA DA LOKALİZE EDEBİLEN LAZER YARDIMLI İNDOSİYANİN YEŞİLİ ANJİOGRAFİNİN KONVANSİYONEL YÖNTEMLE KIYASLANMASI: PROSPEKTİF KLİNİK ÇALIŞMA

Amaç: Bu çalışmada meme-başı koruyucu mastektomi (MBKM) fleplerindeki nekrozu yada nekroz lokalizasyonunu, lazer yardımlı indosiyanin yeşilli angiografinin (LYIYA) tahmin edip edemeyeceğini konvansiyonel gözlem ile kıyaslayarak saptamaktı. Yöntem: Meme kanseri nedeniyle 21 hastaya MBKM ve eşzamalı silikon implant rekonstrüksiyon yapıldı. Ondokuz hastada flep üzerindeki hipoperfuze alanların lazer absorpsiyon derecesini anlamak için LYIYA sayıları kullanıldı. Elde edilen sayılar konvansiyonel gözlem ile kıyaslanarak LYIYA’nın nekroz prediktivitesi saptandı. Bulgular: Bu 19 mastektomi flebinin 3’ünde (15,8%) parsiyel cilt nekrozu saptanmış ve LYIYA sayısı ≤7 olarak saptanmıştır. LYIYA’nın duyarlılığı, özgüllüğü, yalancı pozitifliği ve doğruluğu sırasıyla 43%, 100%, 57%, ve 79% olarak bulunmuştur. LYIYA ≤7 olan hastalarda daha çok nekroz saptanmış, 60 yaş üstü, sigara öyküsü, BMI >30 veya intraoperatif tumescent solusyonu kullanılanlarda LYIYA ≤7 uyumsuz bulunmuş, nekroz tahmininde yanılgıya sebep olmuştur. Sonuç: LYIYA sayısı ≤7 bulgusu, mastektomi flep nekrozunu tahmin edebilmede kullanılabilecek tek anlamlı parametredir. LYIYA aynı anda nekrozun nerde lokalize olduğunu ve sınırlarını da gösterebilmektedir.

Anahtar Kelimeler:

SPY, lazer yardımlı indosiyanin yeşilli angiografi, meme kanseri

LASER-ASSISTED-INDOCYANINE-GREEN-ANGIOGRAPHY VERSUS CONVENTIONAL ASSESSMENT TO PREDICT OR LOCATE NECROTIC AREAS ON MASTECTOMY FLAPS: A PROSPECTIVE CLINICAL TRIAL

Objective: The aim of this study was to determine whether laser-assisted-indocyanine-green-angiography (LA-ICGA) could accurately predict flap necrosis in comparison to conventional clinical assessment and visually identify its location during immediate reconstruction following a nipple-sparing mastectomy (NSM). Methods: Twenty-one patients with breast cancer were prospectively enrolled to undergo NSM with immediate implant reconstruction. In 19 cases LA-ICGA numbers were used to show the level of laser absorption of hypo-perfused areas on the mastectomy flaps. Those numbers were compared to conventional assessment to assess the predictive value of LA-ICGA. Results: Of the 19 mastectomy flaps, 3 (15.8%) examples of partial skin flap necrosis with an LA-ICGA value of ≤7 was observed. The sensitivity, specificity, false-positive rate, and accuracy of LA-ICGA were 43%, 100%, 57%, and 79%, respectively. Patients with an LA-ICGA value of ≤7 were found more likely to develop mastectomy flap necrosis, whereas patients aged >60 or, a history of smoking, a BMI >30, or intraoperative use of tumescence solution containing epinephrine were more likely to have an LA-ICGA score ≤7 which is not clinically reliable in predicting necrosis. Conclusion: Our results indicate that a low LA-ICGA score ≤7 is the only significant factor in predicting mastectomy flap necrosis. LA-ICGA could accurately show the location of necrosis.

Keywords:

SPY, intraoperative angiography, breast Cancer,

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