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. 2016 Oct 6;4(10):e1075.
doi: 10.1097/GOX.0000000000001075. eCollection 2016 Oct.

Management of Tissue Ischemia in Mastectomy Skin Flaps: Algorithm Integrating SPY Angiography and Topical Nitroglycerin

Kyle Sanniec  1 , Sumeet Teotia  1 , Bardia Amirlak  1
Affiliations

Management of Tissue Ischemia in Mastectomy Skin Flaps: Algorithm Integrating SPY Angiography and Topical Nitroglycerin

Kyle Sanniec et al. Plast Reconstr Surg Glob Open. .

Abstract

Tissue ischemia can be managed in several different ways based on the cause of the perfusion defect, including topical nitroglycerin or surgical intervention. However, there are times when tissue perfusion is questioned and clinical examination is unable to determine definitively the cause of ischemic tissue and whether it will survive. In this technique article, we describe our comprehensive algorithm for the management of tissue ischemia in mastectomy skin flaps, which can be applied to other plastic surgery procedures by integrating SPY angiography and topical nitroglycerin.

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Figures

Fig. 1.
Fig. 1.
Spy angiography algorithm.
Fig. 2.
Fig. 2.
Spy angiography before nitropaste application. Mastectomy skin flap with areas of decreased perfusion on SPY angiography.
Fig. 3.
Fig. 3.
SPY angiography after nitropaste application. Note the improved perfusion throughout the area that the nitropaste was applied.
Fig. 4.
Fig. 4.
Application of nitropaste to ischemic area identified with SPY angiography. No more than 2 packets (15 mg) of topical nitroglycerin is used. The nitropaste is applied and spread thin until a see-through layer is placed over the area of concern. The angiography is performed immediately before and after the application of nitropaste to evaluate for improvement in perfusion.
See this image and copyright information in PMC

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