Revolutionizing Precision of Necrosis: Laser Speckle Contrast Imaging versus Indocyanine Green for Breast Flap Viability

Background: Immediate breast reconstruction helps breast cancer patients regain physical and emotional confidence, but the risk of skin flap necrosis can lead to reconstruction failure. Laser speckle contrast imaging (LSCI) has emerged as an innovative technique for predicting necrosis. This study prospectively compared the effectiveness of indocyanine green (ICG) fluorescence imaging with LSCI in predicting the risk of necrosis after direct-to-implant reconstruction. Methods: This study included 87 patients undergoing mastectomy and immediate reconstruction from December of 2022 to January of 2024. Perfusion of the 195 measurement units, including nipple-areola complex and peri-incision skin flaps, was assessed by both LSCI and ICG imaging intraoperatively and postoperatively. Results: A total of 195 measurement units were analyzed, showing significant differences in perfusion values between surviving and necrotic flaps. LSCI demonstrated superior sensitivity (87.10% versus 81.82%), with a perfusion threshold of 37.93% intraoperatively and 22.84% postoperatively. ICG imaging showed higher specificity (80.42% versus 71.60%) but was limited to a single intraoperative use. Conclusions: Both LSCI and ICG were superior predictors of postoperative flap necrosis. LSCI offers the advantage of repeated measurements, making it a versatile tool for ongoing assessment. While the 2 methods showed consistent differences in measured values, LSCI may serve as a viable alternative to ICG in evaluating tissue viability.