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FF001/#960  Near-infrared fluorescence assessment of myocutaneous flap microperfusion for gynecologic reconstruction: final analysis of a prospective non-randomized surgical trial
  1. Beryl Manning-Geist1,
  2. Alanna Jamner2,
  3. Elizabeth Burke1,
  4. Qin Zhou3,
  5. Alexia Iasonos3,
  6. Mario Leitao1,
  7. Anoushka Afonso4,
  8. Jennifer Mueller1,
  9. Farooq Shahzad1,
  10. Michelle Coriddi1,
  11. Joseph Dayan1,
  12. Iris Wei1,
  13. Colleen Mccarthy1,
  14. Ginger Gardner1,
  15. Evan Matros1,
  16. Vance Broach1,
  17. Jonas Nelson1,
  18. Yukio Sonoda1,
  19. Babak Mehrara1 and
  20. Nadeem Abu-Rustum1
  1. 1Memorial Sloan Kettering Cancer Center, Surgery, New York, USA
  2. 2Memorial Sloan Kettering Cancer Center, Medicine, New York, USA
  3. 3Memorial Sloan Kettering Cancer Center, Epidemiology and Biostatistics, New York, USA
  4. 4Memorial Sloan Kettering Cancer Center, Anesthesiology and Critical Care Medicine, New York, USA

Abstract

Introduction Flap-based reconstruction after pelvic exenteration is associated with high rates of wound complications, partly due to impaired perfusion.

Description In this non-randomized phase II trial (NCT05071976), perfusion of pedicled flap-based reconstruction was evaluated using near-infrared (NIR) angiography following pelvic exenteration. The primary endpoint was percentage of patients in whom intraoperative NIR angiography led to a change in flap reconstruction management, calculated assuming binomial proportions, with a change in ≥13.3% of cases indicating the technology was worthy of additional investigation. Among 15 patients, 10 (66.7%) underwent total, 3 (20.0%) underwent posterior, and 2 (13.3%) underwent anterior pelvic exenteration. All patients underwent reconstruction with a vertical rectus abdominis myocutaneous flap. Changes in intraoperative flap reconstruction management based on NIR angiography findings occurred in 8 patients (53.3%), including trimming poorly perfused areas (n=7) and abandoning the flap (n=1). Surgeons were consistently able to discriminate between areas of maximal and least perfusion, as measured by NIH Image J calculated pixilation. Two patients (13.3%) experienced a 30-day postoperative wound complication—both grade 2 complications of necrosis. In this small sample size, the 2 patients who experienced necrosis had lower median global flap perfusion at 60 seconds (43.6, IQR: 26.2-61.1) compared to patients who did not experience postoperative necrosis (100.2, IQR: 92.9-111.3) (P=0.036).

Conclusion/Implications Introduction of NIR angiography after flap-based reconstruction led to altered intraoperative management in 53.3% of patients, meeting the study’s primary endpoint. Our findings can inform future randomized controlled trials investigating if this technology improves postoperative outcomes.

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