D157. Intraoperative Indocyanine Green Angiography for Detecting Quantitative Flap Perfusion Changes in Deep Inferior Epigastric Perforator Flap Breast Reconstruction with Second Venous Drainage

PURPOSE: There is a need for quantitative understanding of the changes in flap perfusion following second anastomosis in deep inferior epigastric perforator (DIEP) breast reconstructions. This study compares perfusion dynamics using indocyanine green videoangiography (ICG-VA) before and after the creation of a second venous anastomosis between the SIEV and retrograde IMV. METHODS: ICG-VA performed during DIEP reconstructions was analyzed prospectively. Areas of interest were above the perforators with the highest intensity (complete perfusion), most distal lateral edge of the flap (partial perfusion), and next lowest intensity (ischemic). We compared the zone intensities before and after the second venous anastomosis. The second ICG was administered ≥20 minutes after the first injection. Patient characteristics, intraoperative details, and complications were collected. RESULTS: 7 patients (10 breasts) underwent DIEP reconstruction. Mean age and BMI were 54.5±12.4 years and 27.6±3.4 kg/m2, respectively. Mean operative duration was 575.5±172.6. Donors included DIEV (n=10, 100.0%), SIEV (n=9, 90.0%), and SCIV (n=1, 10.0%). DIEVs were anastomosed to the antegrade IMV. SIEVs were anastomosed to the retrograde IMV. Mean peak intensity of the complete perfusion zone before and after second venous anastomosis were 160.7±42.1 and 188±42.1, respectively (p=0.163). Mean peak intensity of the partial perfusion zone were 100.8±21.5 and 152±31.5, respectively (p<0.001). Mean peak intensity of the ischemic zone were 90.4±37.4 and 143.4±45.3, respectively (p=0.012). CONCLUSION: These findings highlight the potential benefits of the super drainage technique in enhancing perfusion and reducing complications, emphasizing the need for further investigation and consideration of this technique in clinical practice.