Abstract
Since its introduction, the pedicled transverse rectus abdominis myocutaneous flap (TRAM flap) became a popular procedure for postmastectomy breast reconstruction. Preference for the pedicled TRAM flap was based on its sufficient volume for reconstruction, natural appearing result, acceptable scar of the donor site, and the avoidance of complications caused by the use of implant. However, the perfusion of the pedicled TRAM flap is not as reliable as expected, because this flap has the better blood flow through the inferior epigastric vessels than through the superior epigastric vessels. In general, all the tissue in zone IV of the flap and the parts of the skin in zone II and III tend to be necrotic. When the flap is designed as larger than usual, the inferior epigastric system on the ipsilateral side is prepared for microvascular augmentation.
The traditional methods for evaluating flap circulation, such as examining tissue color, capillary refilling, and dermal bleeding, are based on subjective clinical assessment and can be inaccurate even when used by experienced surgeons. There is still no definitive method of evaluating flap circulation and viability with reasonable objectivity and wide acceptance, instead of several objective techniques. Indocyanine green (ICG) fluorescence angiography is a new method for evaluation of flap circulation. Two ml of 0.25 % ICG solution was injected intravenously, and the fluorescence imaging was obtained by a newly developed near-infrared camera system (PDE, Hamamatsu Photonics K.K. Hamamatsu, Japan). Vascular flow and flap perfusion could be visualized intraoperatively without requiring much time or complexity. The advantages of this method are that real-time information is obtainable and that characteristic fluorescence patterns (such as filling defects, slow filling, and weak fluorescence) are associated with critical flap perfusion deficits, especially in high-risk patients.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Davidge KM, Brown M, Morgan P et al (2013) Processes of care in autogenous breast reconstruction with pedicled TRAM flaps: expending postoperative discharge in an ambulatory setting. Plast Reconstr Surg 132:339e–344e
Zenn MR (2014) Unipedicled TRAM breast reconstruction. http://emedicine.medscape.com/article/1274334-overview#a0101, Mar 3, 2014
Taylor GI (1988) Discussion for Miller LB, Bostwick J, Hartrampf CR, et al: The superiorly based rectus abdominis flap: predicting and enhancing its blood supply based on an anatomic and clinical study. Plast Reconstr Surg 81:721–724
Moon HK, Taylor GI (1988) The vascular anatomy of rectus abdominis musculocutaneous flaps based on the deep superior epigastric system. Plast Reconstr Surg 82:815–829
Hartrampf CR, Scheflan M, Black PW (1982) Breast reconstruction with a transverse abdominal island flap. Plast Reconstr Surg 69:216–224
Scheflan M, Dinner MI (1983) The transverse abdominal island flap: Part I. Indications, contraindications, results, and complications. Ann Plast Surg 10:24–35
Scheflan M, Dinner MI (1983) The transverse abdominal island flap: Part II. Surgical technique. Ann Plast Surg 10:120–129
Millar LB, Bostwick J, Hartramph CR et al (1988) The superiorly based rectus abdominis flap: predicting and enhancing its blood supply based on an anatomic and clinical study. Plast Reconstr Surg 81:713–720
Harashina T, Sone K, Inoue T et al (1987) Augmentation of circulation of pedicled transverse rectus abdominis musculocutaneous flaps by microvascular surgery. Br J Plast Surg 40:367–370
Yamamoto Y, Nohira K, Sugihara T et al (1996) Superiority of the microvascularly augmented flap: analysis of 50 transverse rectus abdominis myocutaneous flaps for breast reconstruction. Plast Reconstr Surg 97:79–83
Mathes SJ, Lang J (2006) Transverse rectus abdominis musculocutaneous (TRAM) transposition flap. VI Trunk and lower extremity. In: Mathes SJ (ed) Plastic surgery, 2nd edn. Saunders, Philadelphia, pp 712–761
Suzuki A, Fujiwara M, Mizukami T et al (2008) Delayed distally based super sural flap: evaluation by indocyanine green fluorescence angiography. J Plast Reconstr Aesthet Surg 61:467–469
Ishihara H, Otomo N, Suzuki A et al (1998) Detection of capillary protein leakage by glucose and indocyanine green dilutions during the early post-burn period. Burns 24:525–531
Holm C, Mayr M, Hofter E et al (2002) Intraoperative evaluation of skin-flap viability using laser-induced fluorescence of indocyanine green. Br J Plast Surg 55:635–644
Krishnan KG, Schackert G, Steinmeier R (2005) The role of near-infrared angiography in the assessment of post-operative venous congestion in random pattern, pedicled island and free flaps. Br J Plast Surg 58:330–338
Still J, Law E, Dawson J et al (1999) Evaluation of the circulation of reconstructive flaps using laser-induced fluorescence of indocyanine green. Ann Plast Surg 42:266–274
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2016 Springer Japan
About this chapter
Cite this chapter
Fukamizu, H., Fujiwara, M., Mizukami, T., Nagata, T. (2016). Intraoperative Evaluation of Flap Circulation by ICG Fluorescence Angiography in the Breast Reconstruction with Pedicled TRAM Frap. In: Kusano, M., Kokudo, N., Toi, M., Kaibori, M. (eds) ICG Fluorescence Imaging and Navigation Surgery. Springer, Tokyo. https://doi.org/10.1007/978-4-431-55528-5_21
Download citation
DOI: https://doi.org/10.1007/978-4-431-55528-5_21
Published:
Publisher Name: Springer, Tokyo
Print ISBN: 978-4-431-55527-8
Online ISBN: 978-4-431-55528-5
eBook Packages: MedicineMedicine (R0)