Using ICG to Streamline Perforator Selection in DIEP Flap Reconstruction: Retrospective cohort study of outcomes in our first one hundred flaps

The use of indocyanine green in conjunction with near infra-red fluoroscopy as an adjunct to the clinical assessment of tissue perfusion is now well established.^1-3 Its intraoperative use in breast reconstruction with deep inferior epigastric (DIEP) flaps has been described since 2009.^4-6 Fat necrosis is commonly encountered in the recovery period. This study reports on our step-by-step practical technique of using indocyanine green (ICG) to streamline perforator choice intraoperatively during DIEP flap raising for breast reconstruction and our rates of fat necrosis (8%) and flap survival (100%) within the first 100 flaps in our regional reconstruction unit. We discuss the benefits and pitfalls of using ICG fluoroscopy at various stages of breast reconstruction with free DIEP flaps. This study has been reported using the STROBE guidelines.