Perioperative Hyperspectral Imaging to Assess Mastectomy Skin Flap and DIEP Flap Perfusion in Immediate Autologous Breast Reconstruction: A Pilot Study
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...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2022-01-01
|
| Series: | Diagnostics |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2075-4418/12/1/184 |
| _version_ | 1797494688085704704 |
|---|---|
| author | Tim Pruimboom Anouk A. M. A. Lindelauf Eric Felli John H. Sawor An E. K. Deliaert René R. W. J. van der Hulst Mahdi Al-Taher Michele Diana Rutger M. Schols |
| author_facet | Tim Pruimboom Anouk A. M. A. Lindelauf Eric Felli John H. Sawor An E. K. Deliaert René R. W. J. van der Hulst Mahdi Al-Taher Michele Diana Rutger M. Schols |
| author_sort | Tim Pruimboom |
| collection | DOAJ |
| description | 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 (StO<sub>2</sub>%), 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 StO<sub>2</sub>%, NIR%, and TWI% were observed when compared to the vital group. StO<sub>2</sub>% was found to be the most sensitive parameter to detect MSFN with a statistically significant lower mean StO<sub>2</sub>% (51% in the vital group versus 32% in the necrosis group, <i>p</i> < 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. |
| first_indexed | 2024-03-10T01:37:56Z |
| format | Article |
| id | doaj.art-eeb6208b02a74f15b2e971e7f16d4038 |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-10T01:37:56Z |
| publishDate | 2022-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-eeb6208b02a74f15b2e971e7f16d40382023-11-23T13:29:46ZengMDPI AGDiagnostics2075-44182022-01-0112118410.3390/diagnostics12010184Perioperative Hyperspectral Imaging to Assess Mastectomy Skin Flap and DIEP Flap Perfusion in Immediate Autologous Breast Reconstruction: A Pilot StudyTim Pruimboom0Anouk A. M. A. Lindelauf1Eric Felli2John H. Sawor3An E. K. Deliaert4René R. W. J. van der Hulst5Mahdi Al-Taher6Michele Diana7Rutger M. Schols8Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, 6200 MD Maastricht, The NetherlandsDepartment of Cardiothoracic Surgery, Maastricht University Medical Center, 6229 HX Maastricht, The NetherlandsDepartment of Visceral Surgery and Medicine, University of Bern, 3010 Bern, SwitzerlandDepartment of Plastic, Reconstructive, and Hand Surgery, VieCuri Medical Center, 5912 BL Venlo, The NetherlandsDepartment of Plastic, Reconstructive, and Hand Surgery, VieCuri Medical Center, 5912 BL Venlo, The NetherlandsDepartment of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, 6200 MD Maastricht, The NetherlandsDepartment of Surgery, Maastricht University Medical Center, 6229 HX Maastricht, The NetherlandsResearch Institute Against Digestive Cancer (IRCAD), 67000 Strasbourg, FranceDepartment of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, 6200 MD Maastricht, The NetherlandsMastectomy 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 (StO<sub>2</sub>%), 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 StO<sub>2</sub>%, NIR%, and TWI% were observed when compared to the vital group. StO<sub>2</sub>% was found to be the most sensitive parameter to detect MSFN with a statistically significant lower mean StO<sub>2</sub>% (51% in the vital group versus 32% in the necrosis group, <i>p</i> < 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.https://www.mdpi.com/2075-4418/12/1/184hyperspectral imagingreconstructive surgerybreast reconstructionmastectomy skinflapfree flap |
| spellingShingle | Tim Pruimboom Anouk A. M. A. Lindelauf Eric Felli John H. Sawor An E. K. Deliaert René R. W. J. van der Hulst Mahdi Al-Taher Michele Diana Rutger M. Schols Perioperative Hyperspectral Imaging to Assess Mastectomy Skin Flap and DIEP Flap Perfusion in Immediate Autologous Breast Reconstruction: A Pilot Study Diagnostics hyperspectral imaging reconstructive surgery breast reconstruction mastectomy skin flap free flap |
| title | Perioperative Hyperspectral Imaging to Assess Mastectomy Skin Flap and DIEP Flap Perfusion in Immediate Autologous Breast Reconstruction: A Pilot Study |
| title_full | Perioperative Hyperspectral Imaging to Assess Mastectomy Skin Flap and DIEP Flap Perfusion in Immediate Autologous Breast Reconstruction: A Pilot Study |
| title_fullStr | Perioperative Hyperspectral Imaging to Assess Mastectomy Skin Flap and DIEP Flap Perfusion in Immediate Autologous Breast Reconstruction: A Pilot Study |
| title_full_unstemmed | Perioperative Hyperspectral Imaging to Assess Mastectomy Skin Flap and DIEP Flap Perfusion in Immediate Autologous Breast Reconstruction: A Pilot Study |
| title_short | Perioperative Hyperspectral Imaging to Assess Mastectomy Skin Flap and DIEP Flap Perfusion in Immediate Autologous Breast Reconstruction: A Pilot Study |
| title_sort | perioperative hyperspectral imaging to assess mastectomy skin flap and diep flap perfusion in immediate autologous breast reconstruction a pilot study |
| topic | hyperspectral imaging reconstructive surgery breast reconstruction mastectomy skin flap free flap |
| url | https://www.mdpi.com/2075-4418/12/1/184 |
| work_keys_str_mv | AT timpruimboom perioperativehyperspectralimagingtoassessmastectomyskinflapanddiepflapperfusioninimmediateautologousbreastreconstructionapilotstudy AT anoukamalindelauf perioperativehyperspectralimagingtoassessmastectomyskinflapanddiepflapperfusioninimmediateautologousbreastreconstructionapilotstudy AT ericfelli perioperativehyperspectralimagingtoassessmastectomyskinflapanddiepflapperfusioninimmediateautologousbreastreconstructionapilotstudy AT johnhsawor perioperativehyperspectralimagingtoassessmastectomyskinflapanddiepflapperfusioninimmediateautologousbreastreconstructionapilotstudy AT anekdeliaert perioperativehyperspectralimagingtoassessmastectomyskinflapanddiepflapperfusioninimmediateautologousbreastreconstructionapilotstudy AT renerwjvanderhulst perioperativehyperspectralimagingtoassessmastectomyskinflapanddiepflapperfusioninimmediateautologousbreastreconstructionapilotstudy AT mahdialtaher perioperativehyperspectralimagingtoassessmastectomyskinflapanddiepflapperfusioninimmediateautologousbreastreconstructionapilotstudy AT michelediana perioperativehyperspectralimagingtoassessmastectomyskinflapanddiepflapperfusioninimmediateautologousbreastreconstructionapilotstudy AT rutgermschols perioperativehyperspectralimagingtoassessmastectomyskinflapanddiepflapperfusioninimmediateautologousbreastreconstructionapilotstudy |