Usefulness of Indocyanine Green Fluorescence Imaging for Harvesting Internal Mammary Artery Perforator Flaps Around the Inframammary Fold Region

抄録

In a typical surgical setting, the viability of an internal mammary artery perforator flap can be assessed based on the surgeon's clinical findings, including bleeding from the flap, or by use of imaging modalities such as indocyanine green near-infrared fluorescence angiography. However, because neither method is highly sensitive, a combination of these methods is often used to diagnose flap viability. This study describes a case of necrosis of the distal end of an internal mammary artery perforator flap that was used for thoracic skin reconstruction. Indocyanine green near-infrared fluorescence angiography performed on the fifth internal mammary artery perforator flap revealed that the distal end was of poor contrast. However, as the distal end demonstrated sufficient blood flow, we sutured the flap without trimming it. Consequently, the distal end of the flap developed necrosis, which coincided with the area of poor contrast on indocyanine green near-infrared fluorescence angiography. This is probably because of multiple vascular territories and areas around the inframammary fold that lack the lubricating adipofascial system. Thus, indocyanine green near-infrared fluorescence angiography may be a beneficial clinical indicator for evaluating internal mammary artery perforator flap viability around the inframammary fold.