Background and objective: Complications associated with implant-based reconstruction have a spectrum of severity with sequelae ranging from mild aesthetic deformities to additional surgery, reconstructive failure and systemic illness. The purpose of this narrative review of the literature is to provide updated evidence-based information on the management of complications in implant-based reconstruction.

Laser-assisted fluorescent angiography, or indocyanine green (ICG) angiography, has recently become an effective surgical decision-making tool in reducing skin envelope necrosis and downstream complications threatening reconstructive failure. The vascular imaging modality is advantageous in permitting real-time visual assessments of superficial blood flow throughout a procedure. Perfusion of skin edges has been correlated with clinical outcomes by means of an absolute emission score or a relative perfusion percentage, with predictive values for skin envelope necrosis increasing stepwise as scores or perfusion percentages decrease below 8.0 or 45%, respectively.

Conclusions: Important principles in management of short-term complications in implant-based reconstruction include aggressive and early intervention to maximize the chance of reconstructive salvage. Contemporary technological advances have played an important role in both prevention and treatment of complications. Over-arching principles in management of implant-based reconstruction complications focus on preventative techniques and preoperative patient counseling on potential risks, their likelihood, and necessary treatments to allow for informed and shared decision-making.

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