Exploring personalized postoperative non-invasive tissue oximetry in DIEP flap breast reconstruction

Abstract

Early detection of vascular compromise after autologous breast reconstruction is crucial to enable timely re-exploration for flap salvage. Several studies proposed non-invasive tissue oximetry for early identification of ischemia of deep inferior epigastric perforator (DIEP) flaps. The present study aimed to explore the utility of non-invasive tissue oximetry following DIEP flap surgery using a personalized oxygenation threshold. Methods Patients undergoing immediate/delayed DIEP flap surgery were included in this prospective observational study. DIEP flap tissue oxygenation (StO2) was monitored continuously using near-infrared spectroscopy. A baseline measurement was performed by positioning one sensor at the marked position of the major inferior epigastric perforator on the abdomen. A new sensor was positioned postoperatively on the transplanted tissue. In unilateral procedures, postoperative StO2 values of the native breast were also obtained. Measurements were continued for 24 h. Results Thirty patients (42 flaps) were included. Fourteen patients (46.7%) had an uncomplicated postoperative course. A minor complication was observed in thirteen patients; in five patients, at least one major complication occurred, requiring re-exploration. Median StO2 readings were significantly lower in patients with major complications compared to uncomplicated cases. In fourteen unilateral DIEP flap procedures, StO2 values of the native breast were similar to the preoperative baseline measurement (92%; p = 0.452). Conclusions Non-invasive tissue oximetry following DIEP flap surgery could aid in early detection of vascular compromise. StO2 values of the native breast and abdominal wall preoperatively can be used interchangeably and can serve as personalized reference value. Level of evidence: Level IV, diagnostic / prognostic study.

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

“…Consequently, Hyttel-Sorensen et al studied the absolute rStO 2 % values of three different devices and concluded that it is not possible to compare the absolute values for different monitoring systems [ 34 ]. We therefore agree with the previous study of our group that it would be better to define device-specific cut-off values than to generalize values [ 30 ].…”

“…Keller et al reported a lower cut-off value of 30% for tissue oxygenation when using the ViOptix (ViOptix Inc., Fremont, CA, USA) [ 28 ]. In addition, a study by Lindelauf et al reported a cut-off value of approximately 50% when using the foresight (Edwards Lifesciences, Irvine, CA, USA) to measure the rStO 2 % [ 30 ].…”

Near-Infrared Spectroscopy (NIRS) versus Hyperspectral Imaging (HSI) to Detect Flap Failure in Reconstructive Surgery: A Systematic Review

“…Furthermore, they develop sensors with different transmitter-receiver spacing, resulting in different penetration depths, which also affects estimation and calculation of rStO 2 [43]. Hence, it is difficult to define universal cut-off values necessitating prompt intervention [24,44]. In the included studies, most research was performed using the ViOptix device.…”

“…Since sensors need to be used to measure tissue oxygenation with NIRS, not all flaps can be monitored with NIRS. For example, when using the FORE-SIGHT system a flap dimension of at least 50 mm by 30 mm was necessary for proper sensor placement [24]. Furthermore, these sensors are not sterile.…”

“…Flap types, ischemia time, vascular disease, Diabetes Mellitus, smoking, radiotherapy and chemotherapy are described in Table 3. In one study 14 (47%) patients received (neo)-adjuvant therapy prior to surgery consisting of immunotherapy, endocrine therapy, radiation therapy, chemotherapy or a combination of these [24]. Prior abdominal surgery is described in two studies: 52 (26.5%) [25] and 214 (56.5%) in the control group, 356 (53.1%) in the NIRS group [26].…”