| BackgroundBreast cancer is one of the most common malignant tumors in women.Young women with breast cancer account for a large proportion in China.Although we received a good prognosis,we cannot ignore the negative affect of radical operation to patient?s psychology.Relevant literature has been reported,breast reconstruction can alleviate the psychological trauma caused by breast loss and significantly improve the quality of life.Therefore,breast reconstruction is becoming more and more important to breast cancer patients.With pedicle transverse rectus abdominis myocutaneous breast reconstruction which avoid the possible graft rejection own a large amount of tissue to shape,It is particularly applicable to abdominal obesity.However,how to reduce or avoid intraoperative and postoperative flap ischemic necrosis,how to guide flap trim in order to achieve perfect shaping.It is an agent problem to be solved.Studies have shown that indocyanine green(indocyanine green,ICG)angiography can dynamic display flap perfusion intraoperative,and the result is more accurate and reliable.ObjectiveTo investigate the feasibility of using indocyanine green angiography guiding surgical doctor to trim the flap with pedicled transverse rectus abdominis myocutaneous for breast reconstruction.MethodsThe clinical data of 94 patients who were accepted breast reconstruction with TRAM in Cancer Institute and Hospital of Tianjin Medical University and Affiliated Zhengzhou Center Hospital of Zhengzhou University between January 2014 and June 2017,were retrospectively analyzed.Patients were divided into the angiography group(54 cases)and control group(40 cases)according to whether use indocyanine green angiography.Follow-up for 1 year after postoperative to observe abnormal blood supply rate in 12hours,the complications,the effect of breast reconstruction and the satisfaction of patients.Using chi-square and t test to analyze the statistical difference between the angiography group and the control group.ResultsThere were no complications which were related to indocyanine green angiography were found in the angiography group,all the patients whose flap with poor perfusion were trimmed according to angiography satisfied to the breast reconstruction.The flap with abnormal blood supply after operation for 12 hours in the angiography group account for1.9%(1/54)and the control group was 12.5%(5/40),there was no statistical difference(?~2=2.760,P=0.097).The complication rate of flap in the angiography group was 1.9%(1/54)and the control group was 12.5%(5/40),there?s no statistical difference(?~2=2.760,P=0.097).All the patients have been followed up for one year.The postoperative appearance was evaluated the best in the angiography group account for 96.3%(52/54)higher than the control group with 75.0%(30/40),there?s statistical difference(?~2=9.358,P=0.002).Overall satisfaction score in the angiography group was 8.93±0.38 higher than that in the control group with 8.40±0.59,there was statistical difference(t=4.924,P=0.000).Tactile satisfaction score in the angiography group was 8.63±0.53 higher than that in the control group with 8.38±0.59,there were statistical difference(t=2.214,P=0.029).Appearance satisfaction score in the angiography group was 9.80±0.41 higher than that in the control group with 9.30±0.52,there were statistical difference(t=5.032,P=0.000).ConclusionIndocyanine green angiography can dynamically and safely evaluate blood perfusion of reconstruction flap,which is helpful to guide flap trimming and to obtain a better breast appearance. |
PDF Full Text Request