Assessment of Mastectomy Skin Flaps for Immediate Reconstruction with Implants via Thermal Imaging—A Suitable, Personalized Approach?

Abstract

Background: Impaired perfusion of the remaining skin flap after subcutaneous mastectomy can cause wound-healing disorders and consecutive necrosis. Personalized intraoperative imaging, possibly performed via the FLIR ONE thermal-imaging device, may assist in flap assessment and detect areas at risk for postoperative complications. Methods: Fifteen female patients undergoing elective subcutaneous mastectomy and immediate breast reconstruction with implants were enrolled. Pre-, intra- and postoperative thermal imaging was performed via FLIR ONE. Potential patient-, surgery- and environment-related risk factors were acquired and correlated with the occurrence of postoperative complications. Results: Wound-healing disorders and mastectomy-skin-flap necrosis occurred in 26.7%, whereby areas expressing intraoperative temperatures less than 26 °C were mainly affected. These complications were associated with a statistically significantly higher BMI, longer surgery duration, lower body and room temperature and a trend towards larger implant sizes. Conclusion: Impaired skin-flap perfusion may be multifactorially conditioned. Preoperative screening for risk factors and intraoperative skin-perfusion assessment via FLIR ONE thermal-imaging device is recommendable to reduce postoperative complications. Intraoperative detectable areas with a temperature of lower than 26 °C are highly likely to develop mastectomy-skin-flap necrosis and early detection allows individual treatment concept adaption, ultimately improving the patient’s outcome.

Literature review and guide for optimal position in implant-based breast reconstruction

“…Established patient risks factors include obesity, diabetes, hypertension, history of stroke, tobacco use, and radiation therapy ( 41 ). Flap morbidity was identified to be associated with elevated BMI and increased breast volumes ( 42 ). Though not an absolute contraindication, prior radiation therapy is associated with higher rates of complication including loss of prosthesis (18.75%) and infection (21.6%) ( 43 ).…”

An overview of current assessment techniques for evaluating cutaneous perfusion in reconstructive surgery

“…As an advanced, non-invasive and low-cost, mostly smartphone-based [45][46][47][48][49] imaging technique, TI offers valuable insights into graduation of burn depths [45,46], as well as thermal physiology [42].…”

In Situ Monitoring and Assessment of Ischemic Skin Flap by High-Frequency Ultrasound and Quantitative Parameters

“…Therefore, it is crucial to long-term and noninvasively assess the non-buried flap tissue from patients undergoing skin flap surgery to provide appropriate treatment and to avoid the development of possible complications. Typical diagnostic indicators for the assessment of the skin flap include temperature, swelling, and color of the tissue [ 7 ] measured by photograph-based modalities, such as skin photography and dermoscope. Nevertheless, in addition to the accuracy of measurements of these indicators being largely dependent on physician’s experience, the related applicable medical devices are difficult to use long-term and in the in situ assessment of the buried flap and underlying tissues [ 8 ].…”