Skin incision in total mastectomy and relationship to indocyanine green angiography with assessment of skin flap perfusion

Abstract Background This study investigated the cause of skin flap necrosis following total mastectomy to prevent skin flap necrosis. Methods For 79 patients who underwent total mastectomy at our institution, the skin incision line was set at operation, and each dissection distance from the skin incision line to the area of mastectomy was measured and photographed. The photographs were analyzed to determine the skin resection area. The approximate area of the total anterior chest on the operative side was also measured by preoperative positron emission tomography-computed tomography (PET-CT) to determine the ratio of the skin resection area to total anterior chest area on the operative side. The results were compared for the necrosis and non-necrosis groups. Results The skin resection area and the perimeter of the skin incision line were significantly greater in the necrosis group (p = 0.009, 0.004); the ratio of the skin resection area to total anterior chest area on the operative side was also significantly greater in the necrosis group (p = 0.005). Intraoperative indocyanine green angiography showed significant differences in the skin resection area and the ratio of the skin resection area to anterior chest area (p = 0.006, 0.025) compared between the cases with areas of relative perfusion ≤ 11% and two other groups. The skin resection area affected blood perfusion of the skin flap, causing a partial reduction in blood flow. Conclusions In total mastectomy, larger skin resection significantly increases the risk of necrosis due to reduced blood perfusion of the skin flap.