Intraoperative Laser Speckle Contrast Imaging in DIEP Breast Reconstruction: A Prospective Case Series Study

Abstract

Introduction: 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.

Deep Learning-Based Image Analysis for the Quantification of Tumor-Induced Angiogenesis in the 3D In Vivo Tumor Model—Establishment and Addition to Laser Speckle Contrast Imaging (LSCI)

“…LSCI, on the other hand, guarantees the recognition of blood vessels underneath the CAM as long as they are located close to the membrane and display a high perfusion status. This can be attributed to the fact that LSCI has to reach a penetration depth of approximately 300 µm when used for the measurement of dermal blood flow [ 61 , 62 , 63 ]. Therefore, the CAM assay application does not fully display the angiogenic development of deeper vessels and LSCI could be used as an additional tool here.…”

Imaging for thinned perforator flap harvest: current status and future perspectives

“…Through the detection of erythrocyte flow at a tissue depth of 300 μm [ 56 ], superficial dermal perfusion could be noninvasively quantified through speckle pattern change detection. In contrast to ICGA, laser speckle contrast imaging (LSCI) allows wide-field imaging of 24 × 24 cm for continuous perfusion monitoring of a large flap without repetitive dye injection [ 57 ].…”

Handheld wireless laser speckle contrast imaging (LSCI) during DIEP flap breast reconstruction: a pilot study

“…5 For a plastic surgeon, it is important to know which parts of the flap are viable for transplantation, and which parts may not. To et al 6 and Zötterman et al 7 showed that mounted LSCI can measure perfusion differences over the flap, but this has not been shown for a handheld LSCI device. Therefore, the research goal of this pilot study was to investigate whether the built handheld LSCI device could detect perfusion differences across the flap, and how perfusion varied during different stages of surgery.…”