scholarly journals Perioperative Hyperspectral Imaging to Assess Mastectomy Skin Flap and DIEP Flap Perfusion in Immediate Autologous Breast Reconstruction: A Pilot Study

Diagnostics ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. 184
Author(s):  
Tim Pruimboom ◽  
Anouk A. M. A. Lindelauf ◽  
Eric Felli ◽  
John H. Sawor ◽  
An E. K. Deliaert ◽  
...  

Mastectomy skin flap necrosis (MSFN) and partial DIEP (deep inferior epigastric artery perforator) flap loss represent two frequently reported complications in immediate autologous breast reconstruction. These complications could be prevented when areas of insufficient tissue perfusion are detected intraoperatively. Hyperspectral imaging (HSI) is a relatively novel, non-invasive imaging technique, which could be used to objectively assess tissue perfusion through analysis of tissue oxygenation patterns (StO2%), near-infrared (NIR%), tissue hemoglobin (THI%), and tissue water (TWI%) perfusion indices. This prospective clinical pilot study aimed to evaluate the efficacy of HSI for tissue perfusion assessment and to identify a cut-off value for flap necrosis. Ten patients with a mean age of 55.4 years underwent immediate unilateral autologous breast reconstruction. Prior, during and up to 72 h after surgery, a total of 19 hyperspectral images per patient were acquired. MSFN was observed in 3 out of 10 patients. No DIEP flap necrosis was observed. In all MSFN cases, an increased THI% and decreased StO2%, NIR%, and TWI% were observed when compared to the vital group. StO2% was found to be the most sensitive parameter to detect MSFN with a statistically significant lower mean StO2% (51% in the vital group versus 32% in the necrosis group, p < 0.0001) and a cut-off value of 36.29% for flap necrosis. HSI has the potential to accurately assess mastectomy skin flap perfusion and discriminate between vital and necrotic skin flap during the early postoperative period prior to clinical observation. Although the results should be confirmed in future studies, including DIEP flap necrosis specifically, these findings suggest that HSI can aid clinicians in postoperative mastectomy skin flap and DIEP flap monitoring.

2014 ◽  
Vol 72 ◽  
pp. S31-S34 ◽  
Author(s):  
Matthew Nykiel ◽  
Zahra Sayid ◽  
Ryan Wong ◽  
Gordon K. Lee

2012 ◽  
Vol 69 (2) ◽  
pp. 139-144 ◽  
Author(s):  
Ketan M. Patel ◽  
Lauren M. Hill ◽  
Margaret E. Gatti ◽  
Maurice Y. Nahabedian

2020 ◽  
Vol 6 ◽  
pp. 2513826X1989883
Author(s):  
Trina V. Stephens ◽  
Nancy Van Laeken ◽  
Sheina A. Macadam

Donor-site seroma formation is a complication of autologous breast reconstruction reported most commonly with the use of latissimus dorsi flaps. First-line treatment is percutaneous aspiration which leads to resolution in the majority of cases. Those that persist may progress to a chronic, refractory seroma, which can prove challenging in terms of treatment. The aim of this article is to provide an updated literature review of interventions for chronic donor-site seroma and present the case of a 65-year-old female with a recalcitrant abdominal seroma following deep inferior epigastric perforator (DIEP) flap breast reconstruction. Literature review revealed a single article that reported 2 cases of persistent donor-site seroma after DIEP flap breast reconstruction. The patient presented here underwent repeat aspiration, drain placement, and multiple surgical procedures to achieve resolution. In total, the post-reconstruction seroma history of the patient extended over approximately 14 months. We conclude with evidence-based suggestions for chronic, donor-site seroma prevention and treatment.


The Breast ◽  
2019 ◽  
Vol 47 ◽  
pp. 102-108 ◽  
Author(s):  
Paloma Malagón-López ◽  
Cristian Carrasco-López ◽  
Oihane García-Senosiain ◽  
Jordi Vilà ◽  
María Del-Río ◽  
...  

2018 ◽  
Vol 34 (07) ◽  
pp. 530-536 ◽  
Author(s):  
Daniel Rais ◽  
Jian Farhadi ◽  
Giovanni Zoccali

Background Although autologous breast reconstruction is technically quite demanding, it offers the best outcomes in terms of durable results, patient perceptions, and postoperative pain. Many studies have focused on clinical outcomes and technical aspects of such procedures, but few have addressed the impact of various flaps on patient recovery times. This particular investigation entailed an assessment of commonly used flaps, examining the periods of time required to resume daily activities. Methods Multiple choice questionnaires were administered to 121 patients after recovery from autologous reconstruction to determine the times required in returning to specific physical activities. To analyze results, the analysis of variance F-test was applied, and odds ratios (ORs) were determined. Results Among the activities surveyed, recovery time was not always a function of free-flap surgery. Additional treatments and psychological effects also contributed. Adjuvant chemotherapy increased average downtime by 2 weeks, and postoperative irradiation prolonged recovery as much as 4 weeks. Patient downtime was unrelated to flap type, ranging from 2.9 to 21.3 weeks for various activities in question. Deep inferior epigastric perforator (DIEP) flaps yielded the highest OR and transverse upper gracilis (TUG) flaps the lowest. Conclusion Compared with superior gluteal artery perforator and TUG flaps, the DIEP flap was confirmed as the gold standard in autologous breast reconstruction, conferring the shortest recovery times. All adjuvant therapies served to prolong patient recovery as well. Surgical issues, patient lifestyles, and donor-site availability are other important aspects of flap selection.


2012 ◽  
Vol 129 (5) ◽  
pp. 778e-788e ◽  
Author(s):  
Brett T. Phillips ◽  
Steven T. Lanier ◽  
Nicole Conkling ◽  
Eric D. Wang ◽  
Alexander B. Dagum ◽  
...  

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