Outcomes using indocyanine green angiography with perforator-sparing component separation technique for abdominal wall reconstruction.

MedStar author(s):
Citation: Surgical Endoscopy. 2019 Jul 24PMID: 31342259Institution: MedStar Washington Hospital CenterDepartment: SurgeryForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: IN PROCESS -- NOT YET INDEXEDYear: 2019Local holdings: Available online from MWHC library: 1997 - present, Available in print through MWHC library: 2000 - 2006ISSN:
  • 0930-2794
Name of journal: Surgical endoscopyAbstract: BACKGROUND: Usage of intraoperative indocyanine green (ICG) to assess skin flaps prior to abdominal wall closure has been shown to decrease postoperative wound-related complications. Primary outcome assessed is the utility of ICG in intraoperative decision making. Secondary outcomes analyzed are the incidence of surgical site occurrence (SSO) and hernia recurrence rates.CONCLUSION: Intraoperative ICG assessment of subcutaneous skin flaps with a perforator-sparing component separation does not result in a decrease in surgical site occurrences.METHODS: A retrospective study using the MedStar Georgetown University Hospital database was conducted, incorporating all consecutive patients undergoing complex incisional hernia repair from 2008 to 2018. 146 patients underwent perforator-sparing component separation (PSCST), 88 underwent flap assessment using intraoperative ICG angiography; they were then analyzed based on patient comorbidities, Ventral Hernia Working Group grade, operative factors, and complications.RESULTS: A total of 146 patients were analyzed with no statistical difference in patient characteristics between the SPY and no SPY group except in BMI (30.2 vs. 33.2 kg/m<sup>2</sup>, p = 0.036). The no SPY group also had higher numbers of patients undergoing concurrent panniculectomy (12 vs. 1, p < 0.001), and extensive lysis of adhesions (30 vs. 31, p = 0.048). Of the 88 patients undergoing intraoperative SPY, 37 (42%) patients had a change of intraoperative management as defined by further subcutaneous skin flap debridement. Despite this change, there was no statistical difference in incidence of SSO between SPY and no SPY (24.3% vs. 11.8%, p = 0.12), and no difference in hernia recurrence rates 5.6% (n = 5) versus 13.7% (n = 8), p = 0.09.All authors: Alimi Y, Bhanot P, Conroy D, Shao JMFiscal year: FY2020Digital Object Identifier: Date added to catalog: 2019-08-23
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 31342259 Available 31342259

Available online from MWHC library: 1997 - present, Available in print through MWHC library: 2000 - 2006

BACKGROUND: Usage of intraoperative indocyanine green (ICG) to assess skin flaps prior to abdominal wall closure has been shown to decrease postoperative wound-related complications. Primary outcome assessed is the utility of ICG in intraoperative decision making. Secondary outcomes analyzed are the incidence of surgical site occurrence (SSO) and hernia recurrence rates.

CONCLUSION: Intraoperative ICG assessment of subcutaneous skin flaps with a perforator-sparing component separation does not result in a decrease in surgical site occurrences.

METHODS: A retrospective study using the MedStar Georgetown University Hospital database was conducted, incorporating all consecutive patients undergoing complex incisional hernia repair from 2008 to 2018. 146 patients underwent perforator-sparing component separation (PSCST), 88 underwent flap assessment using intraoperative ICG angiography; they were then analyzed based on patient comorbidities, Ventral Hernia Working Group grade, operative factors, and complications.

RESULTS: A total of 146 patients were analyzed with no statistical difference in patient characteristics between the SPY and no SPY group except in BMI (30.2 vs. 33.2 kg/m<sup>2</sup>, p = 0.036). The no SPY group also had higher numbers of patients undergoing concurrent panniculectomy (12 vs. 1, p < 0.001), and extensive lysis of adhesions (30 vs. 31, p = 0.048). Of the 88 patients undergoing intraoperative SPY, 37 (42%) patients had a change of intraoperative management as defined by further subcutaneous skin flap debridement. Despite this change, there was no statistical difference in incidence of SSO between SPY and no SPY (24.3% vs. 11.8%, p = 0.12), and no difference in hernia recurrence rates 5.6% (n = 5) versus 13.7% (n = 8), p = 0.09.

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