scholarly journals Exploring personalized postoperative non-invasive tissue oximetry in DIEP flap breast reconstruction

2021 ◽  
Author(s):  
Anouk A. M. A. Lindelauf ◽  
Nousjka P. A. Vranken ◽  
Rutger M. Schols ◽  
Esther A. C. Bouman ◽  
Patrick W. Weerwind ◽  
...  
Keyword(s):  
Early Detection ◽  
Breast Reconstruction ◽  
Near Infrared ◽  
Diep Flap ◽  
Baseline Measurement ◽  
Flap Surgery ◽  
Level Of Evidence ◽  
Non Invasive ◽  
Vascular Compromise ◽  
Tissue Oximetry

Abstract Early detection of vascular compromise after autologous breast reconstruction is crucial to enable timely re-exploration for flap salvage. Several studies proposed non-invasive tissue oximetry for early identification of ischemia of deep inferior epigastric perforator (DIEP) flaps. The present study aimed to explore the utility of non-invasive tissue oximetry following DIEP flap surgery using a personalized oxygenation threshold. Methods Patients undergoing immediate/delayed DIEP flap surgery were included in this prospective observational study. DIEP flap tissue oxygenation (StO2) was monitored continuously using near-infrared spectroscopy. A baseline measurement was performed by positioning one sensor at the marked position of the major inferior epigastric perforator on the abdomen. A new sensor was positioned postoperatively on the transplanted tissue. In unilateral procedures, postoperative StO2 values of the native breast were also obtained. Measurements were continued for 24 h. Results Thirty patients (42 flaps) were included. Fourteen patients (46.7%) had an uncomplicated postoperative course. A minor complication was observed in thirteen patients; in five patients, at least one major complication occurred, requiring re-exploration. Median StO2 readings were significantly lower in patients with major complications compared to uncomplicated cases. In fourteen unilateral DIEP flap procedures, StO2 values of the native breast were similar to the preoperative baseline measurement (92%; p = 0.452). Conclusions Non-invasive tissue oximetry following DIEP flap surgery could aid in early detection of vascular compromise. StO2 values of the native breast and abdominal wall preoperatively can be used interchangeably and can serve as personalized reference value. Level of evidence: Level IV, diagnostic / prognostic study.

scholarly journals Breast softness in patients randomised to postmastectomy breast reconstruction with an expander prosthesis or DIEP flap

2021 ◽  
Author(s):  
Linda Tallroth ◽  
Håkan Brorson ◽  
Nathalie Mobargha ◽  
Patrik Velander ◽  
Stina Klasson ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Subjective Evaluation ◽  
Objective Evaluation ◽  
Applanation Tonometry ◽  
Diep Flap ◽  
Level Of Evidence ◽  
Patient Reported ◽  
Delayed Breast Reconstruction ◽  
Level I ◽  
Therapeutic Study

Abstract Background Objectively measured breast softness in reconstructed breasts and its relation to patients’ subjective satisfaction with breast softness has not yet been investigated. The aim of this study was to evaluate breast softness in patients 1 year following delayed breast reconstruction with an expander prosthesis (EP) or deep inferior epigastric perforator (DIEP) flap, using objective and subjective methods. Methods Seventy-three patients were randomised to breast reconstruction with an EP or DIEP flap between 2012 and 2018. Of these, 69 completed objective evaluation at a mean of 25 (standard deviation, SD 9.4) months following breast reconstruction. Objective evaluation included measurements of breast volume, jugulum-nipple distance, clavicular-submammary fold distance, ptosis and Baker scale grading. Breast softness was assessed with applanation tonometry. Subjective evaluation was performed using the BREAST-Q questionnaire. Results Objectively, DIEP flaps were significantly softer than EP breast reconstructions. Non-operated contralateral breasts were significantly softer compared with reconstructed breasts. In the subjective evaluation, the median score on the question (labelled 1.h) “How satisfied or dissatisfied have you been with the softness of your reconstructed breast (s)?” was higher in the DIEP flap group corresponding to greater satisfaction in this group. A fair correlation was found between the applanation tonometry and the patient-reported satisfaction with the reconstructed breast’s softness (rs = 0.37). Conclusions In terms of breast softness, breast reconstructions with DIEP flaps result in more satisfied patients. Concerning applanation tonometry as an objective tool for softness assessment, future studies on interobserver agreement are warranted. Level of evidence: Level I, therapeutic study

The False Positive Rate of Transcutaneous Tissue Oximetry Alarms in Microvascular Breast Reconstruction Rises after 24 Hours

2020 ◽  
Author(s):  
Phu C. Tran ◽  
Will DeBrock ◽  
Mary E. Lester ◽  
Brett C. Hartman ◽  
Juan Socas ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Postoperative Period ◽  
False Positive ◽  
False Positive Rate ◽  
High Sensitivity ◽  
Flap Loss ◽  
Vascular Compromise ◽  
Positive Rate ◽  
Tissue Oximetry ◽  
Salvage Rate

Abstract Background Transcutaneous tissue oximetry is widely used as an adjunct for postoperative monitoring after microvascular breast reconstruction. Despite a high sensitivity at detecting vascular issues, alarms from probe malfunctions/errors can generate unnecessary nursing calls, concerns, and evaluations. The purpose of this study is to analyze the false positive rate of transcutaneous tissue oximetry monitoring over the postoperative period and assess changes in its utility over time. Patients and Methods Consecutive patients undergoing microvascular breast reconstruction at our institution with monitoring using transcutaneous tissue oximetry were assessed between 2017 and 2019. Variables of interest were transcutaneous tissue oximetry alarms, flap loss, re-exploration, and salvage rates. Results The study included 175 patients (286 flaps). The flap loss rate was 1.0% (3/286). Twelve patients (6.8%) required re-exploration, with 9 patients found to have actual flap compromise (all within 24 hours). The salvage rate was 67.0%. The 3 takebacks after 24 hours were for bleeding concerns rather than anastomotic problems. Within the initial 24-hour postoperative period, 43 tissue oximetry alarms triggered nursing calls; 7 alarms (16.2%) were confirmed to be for flap issues secondary to vascular compromise. After 24 hours, none of the 44 alarms were associated with flap compromise. The false positive rate within 24 hours was 83.7% (36/43) compared with 100% (44/44) after 24 hours (p = 0.01). Conclusion The transcutaneous tissue oximetry false positive rate significantly rises after 24 hours. The benefit may not outweigh the concerns, labor, and effort that results from alarms after postoperative day 1. We recommend considering discontinuing this monitoring after 24 hours.

scholarly journals Increase of major complications with a longer ischemia time in breast reconstruction with a free deep inferior epigastric perforator (DIEP) flap

2019 ◽  
Vol 43 (2) ◽  
pp. 133-138
Author(s):  
Nadine S. Hillberg ◽  
Jop Beugels ◽  
Sander M. J. van Kuijk ◽  
René R. J. W. van der Hulst ◽  
Stefania M. H. Tuinder
Keyword(s):  
Breast Reconstruction ◽  
Medical Center ◽  
Major Complication ◽  
P Value ◽  
Diep Flap ◽  
Level Of Evidence ◽  
Recipient Site ◽  
Ischemia Time ◽  
Flap Loss ◽  
Major Complications

Abstract Background The deep inferior epigastric artery perforator (DIEP) flap is one of the most used free flaps for postmastectomy breast reconstruction. Prolonged ischemia can result in (partial) flap loss. The aim of this study was to evaluate the association between ischemia time and postoperative complications of DIEP flap breast reconstruction. Methods A retrospective study of all patients who received a breast reconstructionwith aDIEP flap atMaastricht University Medical Center in theNetherlands, between January 2010 and June 2017 (n = 677). The flaps were divided into two groups: flaps with an ischemia time less than 60 min and those with 60 min or more. Recipient site complications, in particular major complications equal to re-exploration, and partial or total flap loss were the primary outcome measures. Results In 23.9% of the 677 included DIEP flaps, the ischemia time was 60 min or longer. Within this group, a complication of the recipient site occurred in 30.9% of the flaps. A major complication occurred in 17.3% of the flaps with 60 min or more ischemia time.With regard to the flaps with less than 60-min ischemia time, a complication occurred in 22.1% of the cases of which 8.9%would be considered amajor complication. A significant association was found between ischemia time and major complications on univariate (p value = 0.003) and multivariate analyses (p value = 0.016). Conclusions This study demonstrates that an ischemia time less than 60 min is associated with a significantly lower risk of major recipient site complications compared to an ischemia time of 60 min or more. Level of evidence: Level III, therapeutic, risk/prognostic study.

scholarly journals Infrared Thermography for DIEP Flap Breast Reconstruction Part II: Analysis of the Results

Proceedings ◽  
2019 ◽  
Vol 27 (1) ◽  
pp. 49 ◽  
Author(s):  
Gunther Steenackers ◽  
Ben Cloostermans ◽  
Filip Thiessen ◽  
Yarince Dirkx ◽  
Jan Verstockt ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Infrared Thermography ◽  
Hot Spots ◽  
Breast Surgery ◽  
Infrared Camera ◽  
Diep Flap ◽  
Flap Surgery ◽  
Qualitative Information ◽  
Thermal Measurements ◽  
The Individual

Dynamic infrared thermography (DIRT) has been used to locate perforating vessels and to assist in reconstructive breast surgery. Qualitative information on the perforating vessels is obtained by analysing the rate and pattern of rewarming of hot spots which are easily registered with an infrared camera. Thermal measurements are made before and during surgery and are compared with the CT-images available before operation. The thermal images can provide the individual influence of each perforator on the flap, as well as the dimensions of the perfused area. We will investigate if the influence of the different dominant perforators can be assessed by dynamic infrared thermography as a useful tool for recostructive DIEP-flap surgery.

Monitoring Breast Reconstruction Flaps Using Near-Infrared Spectroscopy Tissue Oximetry

2021 ◽  
Vol 41 (2) ◽  
pp. 108-111 ◽  
Author(s):  
Duygu Ece Kumbasar ◽  
Ahmed Hagiga ◽  
Omar Dawood ◽  
Juan Enrique Berner ◽  
Adam Blackburn
Keyword(s):  
Infrared Spectroscopy ◽  
Breast Reconstruction ◽  
Near Infrared Spectroscopy ◽  
Near Infrared ◽  
Tissue Oximetry

scholarly journals Near-Infrared Spectroscopy (NIRS) versus Hyperspectral Imaging (HSI) to Detect Flap Failure in Reconstructive Surgery: A Systematic Review

Life ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. 65
Author(s):  
Anouk A. M. A. Lindelauf ◽  
Alexander G. Saelmans ◽  
Sander M. J. van Kuijk ◽  
René R. W. J. van der Hulst ◽  
Rutger M. Schols
Keyword(s):  
Systematic Review ◽  
Infrared Spectroscopy ◽  
Hyperspectral Imaging ◽  
Near Infrared Spectroscopy ◽  
Free Flap ◽  
Near Infrared ◽  
Flap Survival ◽  
Non Invasive ◽  
Vascular Compromise ◽  
Flap Monitoring

Rapid identification of possible vascular compromise in free flap reconstruction to minimize time to reoperation improves achieving free flap salvage. Subjective clinical assessment, often complemented with handheld Doppler, is the golden standard for flap monitoring; but this lacks consistency and may be variable. Non-invasive optical methods such as near-infrared spectroscopy (NIRS) and hyperspectral imaging (HSI) could facilitate objective flap monitoring. A systematic review was conducted to compare NIRS with HSI in detecting vascular compromise in reconstructive flap surgery as compared to standard monitoring. A literature search was performed using PubMed and Embase scientific database in August 2021. Studies were selected by two independent reviewers. Sixteen NIRS and five HSI studies were included. In total, 3662 flap procedures were carried out in 1970 patients using NIRS. Simultaneously; 90 flaps were performed in 90 patients using HSI. HSI and NIRS flap survival were 92.5% (95% CI: 83.3–96.8) and 99.2% (95% CI: 97.8–99.7). Statistically significant differences were observed in flap survival (p = 0.02); flaps returned to OR (p = 0.04); salvage rate (p < 0.01) and partial flap loss rate (p < 0.01). However, no statistically significant difference was observed concerning flaps with vascular crisis (p = 0.39). NIRS and HSI have proven to be reliable; accurate and user-friendly monitoring methods. However, based on the currently available literature, no firm conclusions can be drawn concerning non-invasive monitoring technique superiority

scholarly journals Economic Analysis of Noninvasive Tissue Oximetry for Postoperative Monitoring of Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Review

2020 ◽  
pp. 155335062094298
Author(s):  
Anouk A. M. A. Lindelauf ◽  
Nousjka P. A. Vranken ◽  
Vivian G. H. Rutjens ◽  
Rutger M. Schols ◽  
John H. Heijmans ◽  
...  
Keyword(s):  
Economic Analysis ◽  
Breast Reconstruction ◽  
Postoperative Care ◽  
Hospital Costs ◽  
Perforator Flap ◽  
Diep Flap ◽  
Postoperative Monitoring ◽  
Reconstruction Methods ◽  
Deep Inferior Epigastric Perforator ◽  
Tissue Oximetry

Background. Postoperative monitoring of deep inferior epigastric perforator (DIEP) flaps for breast reconstruction using noninvasive tissue oximetry enables timely recognition of vascular compromise. This may limit ischemic tissue damage, minimizing postoperative morbidity and healthcare costs. The aim of this review was to provide an economic analysis of tissue oximetry for postoperative monitoring of DIEP flap breast reconstruction. Methods. A systematic literature search was conducted utilizing PubMed and Embase. Articles reporting costs related to tissue oximetry following DIEP flap breast reconstruction, costs directly related to DIEP flap surgical procedure, and costs associated with postoperative complications were included. Risk of bias was assessed using different tools depending on study type. Results. Six articles were included. Four studies provided an overview of total costs associated with DIEP flap breast reconstruction; two studies focused on whether tissue oximetry could facilitate a decrease in hospital costs. Average overall costs for DIEP flap procedure were estimated at $28 000, with additional costs up to $37 530 in case of total flap failure. Tissue oximetry to monitor DIEP flaps could potentially save up to $1667 per procedure. Moreover, it might eliminate the need for specialized postoperative care. Conclusion. Tissue oximetry following DIEP flap breast reconstruction can potentially facilitate a decrease in hospital costs since its readings enable physicians to intervene in an early stage of tissue malperfusion, contributing to minimizing complications. Tissue oximetry may eliminate the need for specialized postoperative care. However, based on the current literature, no firm conclusions can yet be drawn regarding cost-effectiveness of standard implementation.

scholarly journals The DIEP Flap as Well-established Method of Choice for Autologous Breast Reconstruction with a Low Complication Rate – Retrospective Single-centre 10-Year Experience

2020 ◽  
Vol 80 (06) ◽  
pp. 628-638 ◽  
Author(s):  
Beatrix Munder ◽  
Christoph Andree ◽  
Christian Witzel ◽  
Sonia Fertsch ◽  
Peter Stambera ◽  
...  
Keyword(s):  
Risk Factors ◽  
Breast Reconstruction ◽  
Complication Rate ◽  
Prophylactic Mastectomy ◽  
Diep Flap ◽  
Complication Rates ◽  
Flap Surgery ◽  
Autologous Breast Reconstruction ◽  
Primary Indication ◽  
Low Rate

Abstract Background Breast cancer is the most common cancer affecting women in Germany. Despite breast-conserving therapy (BCT) being carried out in almost 70% of cases, a high number of women still require complete mastectomy. Prophylactic mastectomy is also indicated for women with a BRCA 1/2 gene mutation. In addition to implant-based heterologous breast reconstruction, autologous breast reconstruction using a DIEP flap has been found to be beneficial, particularly for patients who had prior radiotherapy. This study aims to show that DIEP flap reconstruction surgery is the method of choice for autologous breast reconstruction with a low rate of complications. Patients and Methods Autologous breast reconstruction using a DIEP flap was performed in 1124 patients between July 2004 and December 2014. Retrospective study criteria included potential risk factors such as age, BMI, smoking, chemotherapy and/or radiotherapy, and comorbidities as well as outcome parameters such as postoperative complications. Outcomes were evaluated with a mean follow-up of 24 months. Results A total of 1124 patients underwent 1274 free DIEP flap breast reconstructions, of which 150 were bilateral reconstructions. The primary indication was previous mastectomy in 785 cases, followed by prior implant-based reconstruction in 265 cases. The total flap loss rate was 0.6%. Postoperative surgical revision for abdominal wall hernia was required in 0.2% of cases. The group with a higher BMI and the group of smokers had significantly higher complication rates. Elderly patients (> 65 years), patients who had undergone chemo-/radiotherapy and patients with diabetes did not have higher complication rates. Conclusion DIEP flap surgery is an excellent option for autologous breast reconstruction, with a low rate of donor site morbidity and low complication rates. DIEP flap surgery carried out in a specialised interdisciplinary breast centre in a standardised clinical setting after prior careful patient selection to take account of risk factors such as high BMI and smoking is a reliable method with a low complication rate and satisfactory long-term reconstruction results.

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