Fat Necrosis Clinical Trial
— FAFIOfficial title:
Indocyanine Green for Perfusion Assessment of DIEP Flaps: A Dutch Multicenter Randomized Controlled Trial
Currently during DIEP flap reconstruction, the perfusion of the flap is assessed by the clinical view of the surgeon. Identification of demarcated ischemic zones of the DIEP flap could be optimized by using fluorescence imaging with indocyanine green (ICG) in order to lower the rate of fat necrosis. This study evaluates whether intraoperative perfusion assessment with ICG fluorescence imaging causes a lower rate of fat necrosis compared to conventional intraoperative clinical evaluation of DIEP flaps.
Status | Recruiting |
Enrollment | 280 |
Est. completion date | October 1, 2025 |
Est. primary completion date | September 1, 2025 |
Accepts healthy volunteers | No |
Gender | Female |
Age group | 18 Years and older |
Eligibility | Inclusion Criteria: 1. Female patients 18 years of age and older 2. Who underwent a mastectomy for breast cancer or prophylactic due to genetic predisposition 3. Patients scheduled for elective surgery for autologous breast reconstruction, uni- or bilateral, using DIEP or msTRAM flaps. In case of bilateral breast reconstruction the flaps should be bilateral anastomosed. 4. Written informed consent Exclusion Criteria: 1. Allergy to ICG, iodine or shellfish 2. Any medical condition that in the opinion of the investigators could potentially jeopardize the safety of the patient 3. Impaired renal function defined as eGFR< 50 mL/min/1.73m2 (this can be seen in the standard preoperative lab results) |
Country | Name | City | State |
---|---|---|---|
Netherlands | Leiden University Medical Center | Leiden | |
Netherlands | Erasmus Medical Center | Rotterdam |
Lead Sponsor | Collaborator |
---|---|
Leiden University Medical Center |
Netherlands,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Clinical relevant fat necrosis | Clinically relevant fat necrosis is defined as a palpable mass, either painful or not, and with or without aesthetic complaints, and developed within three months after surgery. The following grading system according to Lie et al. is used. Only grade III till IV is classified as clinical relevant fat necrosis.
III: Major compromised reconstructive outcome, flap involvement:15-50%, clinical findings: Major contour defects (multiple), surgical management: Debridement/secondary procedure IV: Subtotal poor reconstructive outcome, flap involvement: >50%, clinical findings: Skin defects, inadequate volume, volume loss, surgical management: Second local flap/ re-intervention initial flap |
3 months | |
Secondary | Quantify perfusion of flaps | Based on NIRF recordings and correlate these to the development of fat necrosis. | 3 months | |
Secondary | Registration of re-interventions | necessary to treat fat necrosis, in numbers and percentages | 3 months | |
Secondary | Registration of postoperative complications | in numbers and percentages | 3 months | |
Secondary | Duration of surgery in minutes | Of all surgical procedures included | 1 day | |
Secondary | Percentage extra resected tissue | of initial flap in grams based on perfusion assessment | 1 day | |
Secondary | Personal experience/opinion of surgeon performing surgery with fluorescent imaging using ICG. | After every surgery the NASA TASK Load Index is taken by the surgeon. | 1 day | |
Secondary | Patient satisfaction | using BREAST-Q questionnaire, this is an validated questionnaire that is used in multiple research for measuring patient satisfaction | 3 months |
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