KEY TAKEAWAYS
- This study assessed the use of near-infrared (NIR) angiography during pedicled flap-based reconstruction after pelvic exenteration.
- The trial’s main objective was to determine how often the intraoperative NIR angiography influenced decisions in flap reconstruction. Another key endpoint was the outcomes 30 days after the procedure.
- The study reported that NIR angiography influenced flap reconstruction decisions in 50% of patients.
This non-randomized study assessed the role of near-infrared (NIR) angiography when reconstructing with a pedicled flap after pelvic exenteration. The study’s main objective was to determine how often the use of intraoperative NIR angiography affected decisions in flap reconstruction. If changes were made in 13.3% or more of the cases due to this technology, it would be considered for further exploration. The secondary outcome was assessing the outcomes 30 days after surgery.
A total of 14 patients (pts) participated, with the average age being 56 years (spanning from 29-74). The reason for exenteration varied: 57% for cervical cancer, 22% for rectal, 14% for vulvar, and 7% for endometrial cancer. Racial and ethnic backgrounds included 50% White non-Hispanic, 29% White Hispanic, 14% Black non-Hispanic, and 7% Asian. The median body mass index was 27.8 kg/m2 (with a range of 16.6-36.1). Smoking was in the history of 22% of the pts. All pts had received chemotherapy and radiation previously.
Of the participants, 64% had total exenteration, 22% had posterior, and 14% had anterior pelvic exenteration. Every patient was reconstructed using a vertical rectus abdominis myocutaneous flap. NIR angiography influenced surgical decisions in 50% of the cases. This included removing regions with insufficient blood flow identified by NIR angiography in 6 cases and opting out of using the pedicled flap in 1 case due to poor blood flow detected by NIR angiography. Only one patient (7%) faced a wound issue—a grade 2 necrosis complication that needed bedside removal and oral antibiotics.
This trial showed that NIR angiography impacted decisions during flap reconstruction surgery in half the pts, achieving the study’s primary goal. These results pave the way for more comprehensive studies to determine whether this tool enhances postoperative outcomes.
Source: https://www.emma.events/site/programme/?sessiondetail=4534535&trackid=0&a=esgo2023#!
Clinical Trial: https://classic.clinicaltrials.gov/ct2/show/NCT05071976
Manning-Geist, B., Jamner, A., Leitao Jr., M.M., Afonso, A., Mueller, J.J., Shahzad, F., Coriddi, M., Dayan, J., Burke, E., Wei, I., Mccarthy, C., Gardner, G., Matros, E., Broach, V., Nelson, J., Sonoda, Y., Mehrara, B., Abu-Rustum, N.R. Near-Infrared FluORescencE Assessment Of Myocutnaeous Flap Microperfusion For Gynecologic RecONstrucTion (FOREFRONT): A Prospective, Non-Randomized Trial (NCT05071976)
