Laser Fluorescent Imaging of Abdominal Skin During Abdominoplasty
Condition: Abdominal Skin Redundancy
Study type: Observational [Patient Registry]

Summary: 
      Abdominoplasty is a common cosmetic operation. Some investigators believe that the risk of
      complications is reduced by limiting the operative dissection. However, this can compromise
      the quality of the result. This study was undertaken to investigate the blood supply of the
      abdominoplasty skin flap during surgery using laser fluorescent imaging. An imaging agent is
      injected and the fluorescence is recorded using a near-infrared laser. The blood supply is
      tested after a limited dissection and then after a traditional dissection to determine
      whether an extended dissection reduces the skin circulation. The study hypothesis is that
      there is no difference in blood supply and the traditional abdominoplasty does not compromise
      skin circulation.
    

Detailed description: 
      Protocol

      Laser Fluorescent Imaging of Abdominal Skin During Abdominoplasty.

      Background/Purpose

      Abdominoplasty (tummy tuck) is a common cosmetic operation. One of the risks of surgery is
      delayed wound healing caused by impaired circulation to the skin. In an effort to reduce
      risk, some investigators1 advocate a limited-undermining technique, with preservation of the
      perforating blood vessels and preservation of the Scarpa fascia of the lower abdomen.
      However, there is no evidence that this limited-undermining technique improves blood supply
      compared with a traditional abdominoplasty dissection. Such a limited dissection may
      compromise the cosmetic result.

      This study was undertaken to investigate the blood supply of the abdominal skin during the
      abdominoplasty procedure. By testing the circulation at two points during the dissection, and
      a third time after completion of the operation, data may be obtained and used to evaluate the
      effect of the extent of the dissection on blood supply of the skin flap.

      Laser fluorescent imaging represents an objective measurement technique that has been used to
      quantitate blood supply in skin flaps and other tissues. It has been used for several years
      to monitor the vascularity of flaps used in breast reconstruction. This technique has also
      been used previously in patients undergoing abdominoplasty.2

      Subjects

      Twenty consecutive consenting adult men and women undergoing outpatient elective
      abdominoplasty will be investigated using laser fluorescent imaging. By testing the blood
      supply at three time points, the patient serves as his or her own control.

      Imaging

      The SPY Elite Intraoperative Perfusion Assessment System (Lifecell Corp., Branchburg, NJ)
      consists of a near-infrared laser that detects fluorescence. The imaging agent, indocyanine
      green, is absorbed at this region of the spectrum, 800-810 nm. The imaging agent is injected
      intravenously. Starting within 5-10 seconds of injection, the system records images of the
      abdomen, showing the fluorescence, which indicates blood supply. The half-life of the imaging
      agent is 2.5-3 minutes. The imaging agent is metabolized by the liver. The only known risk is
      an allergic reaction to the imaging agent. Patients with a history of an allergic reaction to
      iodinated contrast dyes are excluded.

      Surgery

      The lipoabdominoplasty technique is performed as described by Saldanha et al.1 Following this
      limited dissection, 3 mL (7.5 mg) of indocyanine green is injected and the abdominal image is
      recorded, documenting blood supply to the lower abdomen. After further dissection, another 3
      mL of imaging agent is injected and the lower abdomen is re-imaged. On completion of surgery,
      a third injection is administered and a final image is recorded.

      Null Hypothesis

      A traditional abdominoplasty dissection does not compromise circulation compared with a more
      limited dissection technique.

      Informed Consent

      Patients are informed as to the nature of the study and are told that their participation is
      entirely voluntary and they are free to decline, and that doing so does not in any way
      prejudice their treatment. Patients are informed of the small risk of an allergic reaction
      that will be treated if it occurs.

      Patient Risk

      There is no patient risk apart from a very small risk of allergic reaction, which is further
      reduced by excluding any patient with a known allergy to iodinated contrast dye. The study
      does not affect patient treatment. It offers the possibility of detection of reduced skin
      circulation, information that can be used by the surgeon to limit the dissection if necessary
      and avoid tissue loss and delayed wound healing, known complications of abdominoplasty.

      Sample Size

      A sample of 20 patients is anticipated, treated over a period of approximately 6 months.

      Disclosure

      The author has no financial interest in any of the products, devices, or drugs mentioned in
      this article. The author has no conflicts of interest to disclose. There was no outside
      funding for this study.
    

Observational model: Case-Only
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Adult men and women undergoing abdominoplasty.
      
Keywords: Abdominoplasty; circulation; skin; dissection; laser; fluorescence; imaging