Breast reconstruction with an autologous free Deep Inferior Epigastric Perforator (DIEP) flap is one of the preferred options following mastectomy. A challenging step in this procedure is the selection of a suitable perforator that provides sufficient blood supply for the flap. The current golden standard for perforator mapping is computed tomography angiography (CTA). However, this is a relatively expensive imaging modality that requires intravenous contrast injection and exposes patients to ionizing radiation.More recently, dynamic infrared thermography (DIRT) has been proposed as an alternative imaging modality for perforator identification. DIRT appears to be an ideal alternative technique not only for the identification of the dominant perforators, but also for the mapping of the individual influence of each perforator on the flap perfusion. Multiple studies have been performed with the use of DIRT, unfortunately without standardisation of the measurement set-up. In this technical note we propose a standardised and reproducible measurement set-up for the use of DIRT during breast reconstructions with a free DIEP flap. This set-up can be used pre-, intra-and postoperatively. A standardised measurement set-up will improve the quality of measured data and ensure reproducibility.

This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

In the modern world, one-third or more of breast cancer patients still undergo uni-or bilateral mastectomy. Breast cancer patients, in general, have a good prognosis and long-term survival. Therefore, the treatment must not only focus on survival but also on the quality of life. Breast reconstruction with an autologous free deep inferior epigastric artery perforator (DIEP) flap is one of the preferred options after mastectomy. A challenging step in this procedure is the selection of a suitable perforator that provides sufficient blood supply for the flap to prevent necrosis after anastomosis. In this pilot study, the possibilities for dynamic infrared thermography (DIRT) are investigated to select the best suitable perforator. The measurements are done with external cooling in the preoperative stage to accurately predict the location of the dominant perforators. During the surgery, in the peroperative stage, measurements are done for mapping the influence of a specific perforator on the perfused areas of the abdominal flap. Perforators are sequentially closed and opened again to map the influence of that perforator on the vascularization of the flap, visualized with the help of the thermographic camera. The acquired steady-state thermal images could help decide which parts of the abdominal flap to use for the reconstruction so that the chance of (partial) necrosis is reduced. In the postoperative stage, DIRT could visualize the arterial and or venous thrombosis before they become clinically obvious as (partial) necrosis. At present DIRT seems to be a valuable investigation for the pre-, per-, and postoperative phases of DIEP-flap reconstructions. Large, high-quality clinical studies are needed to determine its definitive role.

Modern sealing components are essential in today’s industry. The recent global focus on environment, sustainability and safety is encouraging gasket manufacturers to innovate and think of the gasket of tomorrow. Not only are performance expectations increasing rapidly, but advancements in gasket manufacturing and material technologies are producing gaskets that — in both theory and practice — generate tighter seals and reduce harmful emissions. The major impediment to attaining these results in the field is the lack of advancement in assembly accuracy and real-time monitoring of gasket stress. Currently the user relies on industrial calculation standards that are designed to determine the required bolt load to maintain a leak free seal over the required timeframe. Such calculations often yield a proper approximation of the situation, but they inherently rely on simplifications and assumptions. Furthermore, the correct execution of installation protocols is difficult to verify. The state-of-play does not allow in-situ measurements of the seating stress in the gasket. This study addresses state-of-the-art shortcomings in bolted flange connections and proposes a solution to mitigate them by means of sensors. We successfully integrate optical fiber sensors inside semi-metallic gaskets and experimentally demonstrate the direct measurement of seating stress. Such in-situ seating stress quantification enables installation and condition monitoring serving an optimal lifecycle prediction and failure prevention. As such, this approach contributes to increased sustainability of bolted flange connections.

In order to identify the exact location of a useful perforator for DIEP flap breast reconstruction, CT images are made in the pre-operative phase. The aim of this research is to evaluate if dynamic infrared thermography is a helpful tool to check and visualize the blood flow in the flap during the pre- and peroperative phase. The results will be used in order to pinpoint the usefulness of IR thermography as an alternative method for perforator mapping and flapdesign. By means of infrared thermography the blood vessel distribution and its vascularisation of the abdominal wall will be visualized. The thermal images can help to detect the correct perforator and can help to decide which parts of the flap are best perfused and can be used for the DIEP flap reconstruction.