Indocyanine Green for Perfusion Assessment of DIEP Flaps

Last updated: August 17, 2022
Sponsor: Leiden University Medical Center
Overall Status: Active - Recruiting

Phase

3

Condition

N/A

Treatment

N/A

Clinical Study ID

NCT05507710
NL 68623.058.18
  • Ages > 18
  • Female

Study Summary

Currently during DIEP flap reconstruction, the perfusion of the flap is assessed by the clinical view of the surgeon. Identification of demarcated ischemic zones of the DIEP flap could be optimized by using fluorescence imaging with indocyanine green (ICG) in order to lower the rate of fat necrosis. This study evaluates whether intraoperative perfusion assessment with ICG fluorescence imaging causes a lower rate of fat necrosis compared to conventional intraoperative clinical evaluation of DIEP flaps.

Eligibility Criteria

Inclusion

Inclusion Criteria:

  1. Female patients 18 years of age and older
  2. Who underwent a mastectomy for breast cancer or prophylactic due to geneticpredisposition
  3. Patients scheduled for elective surgery for autologous breast reconstruction, uni- orbilateral, using DIEP or msTRAM flaps. In case of bilateral breast reconstruction theflaps should be bilateral anastomosed.
  4. Written informed consent

Exclusion

Exclusion Criteria:

  1. Allergy to ICG, iodine or shellfish
  2. Any medical condition that in the opinion of the investigators could potentiallyjeopardize the safety of the patient
  3. Impaired renal function defined as eGFR< 50 mL/min/1.73m2 (this can be seen in thestandard preoperative lab results)

Study Design

Total Participants: 280
Study Start date:
May 01, 2019
Estimated Completion Date:
October 01, 2025

Study Description

Rationale: Autologous breast reconstruction after mastectomy due to cancer or prophylactically due to genetically increased risk is frequently performed. A complication that may occur after a deep inferior epigastric artery (DIEP) reconstruction is the occurrence of fat necrosis in the transplanted flap due to ischemia (reperfusion injury). Identification of deep inferior epigastric artery perforators and identification of demarcated ischemic zones of the DIEP flap can be optimized by using fluorescence imaging with indocyanine green (ICG), as has been demonstrated in previous studies. This could result in less fat necrosis, less partial flap loss, and other complications. A randomized controlled trial would be the best study design to assess the value of ICG in determining the perfusion of DIEP flaps, thereby reducing the occurrence of fat necrosis and other complications.

Objective: To determine whether fluorescence imaging using ICG for the assessment of DIEP flap perfusion during surgery decreases the occurrence of fat necrosis compared to standard intraoperative clinical assessment of DIEP flap perfusion.

Study design: This is a two-armed randomized controlled trial:

  • interventional arm: evaluation of flap perfusion based on 1) clinical parameters, and 2) fluorescence imaging using ICG

  • conventional arm: evaluation of flap perfusion based on clinical parameters only

Study population: Patients scheduled for elective surgery for autologous breast reconstruction, uni- or bilateral, using DIEP or muscle sparing transverse rectus abdominis muscle (msTRAM) flaps. Female patients 18 years of age and older.

Intervention (if applicable): evaluation of flap perfusion based on 1) clinical parameters, and 2) fluorescence imaging using ICG

Main study parameters/endpoints: Difference in percentage of fat necrosis after autologous breast reconstruction using DIEP flaps between patients in whom fluorescence imaging was used and patients in whom flaps were clinically assessed.

Connect with a study center

  • Leiden University Medical Center

    Leiden, 2333ZA
    Netherlands

    Active - Recruiting

  • Erasmus Medical Center

    Rotterdam, 3015GD
    Netherlands

    Active - Recruiting

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