To investigate the feasibility of indocyanine green angiography-guided breast reconstruction using the pedicled transverse abdominis myocutaneous (TRAM) flap.

This prospective study analyzed the clinical data of 64 patients who underwent breast reconstruction with TRAM flap in Cancer Institute and Hospital of Tianjin Medical University and Zhengzhou Central Hospital Affiliated to Zhengzhou University between January 2015 and June 2017. All cases were divided into the angiography group (34 cases) and the control group (30 cases) by the random number table method. In the angiography group, indocyanine green angiography was used to guide the trim of the flap, while the flap was trimmed in a conventional way in the control group. The incidence of abnormal blood supply in postoperative 12 hours, the flap-related complications and postoperative appearance of the reconstructed breast were compared between two groups using χ² test. The patient satisfaction was compared between two groups using t test.

In the angiography group, there were no complications related to indocyanine green angiography and the reconstructed breast presented a good appearance after the part of flap was with poor perfusion resected according to the ICG angiography. The incidence of abnormal blood supply in the flap in postoperative 12 hours was 2.9% (1/34) in the angiography group and 13.3% (4/30) in the control group, indicating no significant difference (χ²=1.165, P=0.280). The incidence of flap-related complications was 2.9% (1/34) in the angiography group and 10.0% (3/30) in the control group, indicating no significant difference (χ²=0.418, P=0.518). All the patients were followed up for one year.The patients with good postoperative breast appearance accounted for 97.1% (33/34) in the angiography group, significantly higher than 76.7% (23/30) in the control group (χ²=4.338, P=0.037). The score of overall patient satisfaction was 8.91±0.38 in the angiography group and 8.47±0.57 in the control group, suggesting a significant difference (t=3.622, P= 0.001).

Indocyanine green angiography can dynamically show blood perfusion of the pedicled TRAM flap, which can provide the guidance for flap trimming in order to achieve a better breast appearance.