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Intraoperative Laser Speckle Contrast Imaging in DIEP Breast Reconstruction: A Prospective Case Series Study
Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology.
Department of Plastic and Reconstructive Surgery, University of Ghent, Ghent, Belgium.
Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology.
Department of Plastic and Reconstructive Surgery, University of Ghent, Ghent, Belgium.
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2020 (English)In: Plastic and reconstructive surgery. Global open, ISSN 2169-7574, Vol. 8, no 1, p. e2529-e2529Article in journal (Refereed) Published
Abstract [en]

Laser speckle contrast imaging (LSCI) is a laser-based perfusion imaging technique that recently has been shown to predict ischemic necrosis in an experimental flap model and predicting healing time of scald burns. The aims were to investigate perfusion in relation to the selected perforator during deep inferior epigastric artery perforator (DIEP) flap surgery, and to evaluate LSCI in assisting of prediction of postoperative complications. METHODS: Twenty-three patients who underwent DIEP-procedures for breast reconstruction at 2 centers were included. Perfusion was measured in 4 zones at baseline, after raising, after anastomosis, and after shaping the flap. The perfusion in relation to the selected perforator and the accuracy of LSCI in predicting complications were analyzed. RESULTS: After raising the flap, zone I showed the highest perfusion (65 ± 10 perfusion units, PU), followed by zone II (58 ± 12 PU), zone III (53 ± 10 PU), and zone IV (45 ± 10 PU). The perfusion in zone I was higher than zone III (P = 0.002) and zone IV (P < 0.001). After anastomosis, zone IV had lower perfusion than zone I (P < 0.001), zone II (P = 0.01), and zone III (P = 0.02). Flaps with areas <30 PU after surgery had partial necrosis postoperatively (n = 4). CONCLUSIONS: Perfusion is highest in zone I. No perfusion difference was found between zones II and III. Perfusion <30 PU after surgery was correlated with partial necrosis. LSCI is a promising tool for measurement of flap perfusion and assessment of risk of postoperative ischemic complications.

Place, publisher, year, edition, pages
Wolters Kluwer, 2020. Vol. 8, no 1, p. e2529-e2529
National Category
Surgery
Identifiers
URN: urn:nbn:se:liu:diva-164324DOI: 10.1097/GOX.0000000000002529PubMedID: 32095386OAI: oai:DiVA.org:liu-164324DiVA, id: diva2:1415166
Note

32095386[pmid]; PMC7015619[pmcid]

Available from: 2020-03-17 Created: 2020-03-17 Last updated: 2020-03-23Bibliographically approved
In thesis
1. Laser Speckle Contrast Imaging in Reconstructive Surgery
Open this publication in new window or tab >>Laser Speckle Contrast Imaging in Reconstructive Surgery
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Objectives

Reconstructive surgery aims to restore function or normal appearance by reconstructing defective organs after trauma or disease. In patients undergoing reconstructive surgery, previous trauma, surgery or radiotherapy can result in compromised blood supply. This will affect the viability of the tissue and increases the risk for postoperative complications, such as ischemia and infection. It is therefore important to assess the tissue viability, both before, during and after the surgery. This can be done using different techniques that monitor the perfusion of the skin covering the affected area. In this thesis, LSCI have been evaluated for tissue monitoring in reconstructive surgery. The technique allows for a fast and noninvasive assessment of superficial tissue perfusion over a wide field. Based on previous work on the technology, we have seen clear advantages with LSCI compared to other methods, for example laser Doppler flowmetry (LDF). We have evaluated laser speckle contrast imaging (LSCI) as a tool for tissue monitoring in reconstructive surgery in four studies.

Methods

In study I we used a bench top model and healthy subjects to address methodological concerns subjected to the LSCI technology. We investigated the effect of motion distance and angle on the assessed perfusion value In study II we used a porcine model to compare LSCI and LDF as tools to detect partial and full venous outflow obstruction. We used both methods to assess a flap based on the cranial gluteal artery perforator with partial and complete occlusion of the vein and artery. In study III we used the same porcine model as in study II to investigate the possibility to use LSCI intraoperatively to identify flap areas with compromised circulation and thereby predict areas with a high risk of postoperative necrosis. In study IV we used LSCI for intraoperative evaluation of tissue viability during deep inferior epigastric perforator (DIEP) free flap surgery and to investigate the perfusion distribution according to the Hartrampf zones, as measured with LSCI, in relation to the selected perforator in the deep inferior epigastric perforator free flap.

Results

In study I we saw that tissue perfusion as measured with LSCI increases with increasing tissue motion, independent of frame rate, number of images, and tissue perfusion. Measured perfusion will decrease when images are acquired at an angle larger than 45° but distances between 15 and 40 cm do not affect the measured perfusion. In study II we observed significant decreases in perfusion during both partial and complete venous occlusion with both LSCI and LDF. However, higher variability seen with LDF, measured as % coefficient of variation. In study III a decrease in perfusion during the first 30 min after raising the flap and a perfusion value below 25 PU after 30 min was a predictor for tissue morbidity 72h after surgery. In study IV the highest perfusion values were found in zone I and higher perfusion in zone II compared to zone III, directly after the flap was raised. No remaining significant difference between zone I, II and III could be seen after anastomosis of the vessels. All flaps with a minimum perfusion <30 PU, measured after the flap was shaped and inserted, later suffered from partial flap necrosis.

Conclusion

LSCI is a technology that has the potential to contribute to tissue monitoring in reconstructive surgery. It has many advantages over other techniques, such as the fast acquisition time, the spatial resolution and the fact that it is completely non-invasive. However, the current system is still too bulky to be easily introduced into a clinical setting and the technology is also subject to certain drawbacks which limit its usability. It is sensitive to motion artefacts; only superficial tissue is assessed and cannot offer absolute perfusion data. If these disadvantages could be addressed, LSCI could contribute to a more accurate survey of tissue perfusion and thus better outcome in reconstructive surgery.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2020. p. 76
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1735
National Category
Medical Laboratory and Measurements Technologies
Identifiers
urn:nbn:se:liu:diva-164328 (URN)10.3384/diss.diva-164328 (DOI)9789179298722 (ISBN)
Public defence
2020-04-17, Eken, Building 421, Entrance 65, Campus US, Linköping, 09:00 (Swedish)
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Available from: 2020-03-18 Created: 2020-03-18 Last updated: 2020-03-26Bibliographically approved

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Zötterman, JohanFarnebo, SimonTesselaar, Erik

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