Intraoperative Perfusion Assessment in Mastectomy Skin Flaps: How Close are We to Preventing Complications?

Abstract

Background Mastectomy flap necrosis is the source of considerable morbidity and cost following breast reconstruction. A great deal of effort has been put forth to predicting and even preventing its incidence intraoperatively. Methods A review of the literature was performed evaluating the evidence of mastectomy skin flap perfusion technologies. Results Multiple technologies have leveraged spectroscopy and/or angiography to provide real-time assessment of flap perfusion, including indocyanine green, fluorescein, and light-based devices. Conclusion This manuscript endeavors to review the evidence on mastectomy skin flap perfusion analysis, highlighting the benefits, and downsides of the current technologies and identifying exciting areas of future research and development.

Comparison of the ViOptix Intra.Ox Near Infrared Tissue Spectrometer and Indocyanine Green Angiography in a Porcine Bowel Model

“…20 Commercially available systems, including the SPY, combine an infrared sensor, light source, and monitor that allow for the visualization of ICG throughout the tissue of interest. Preliminary studies have evaluated this technology in a variety of settings 3,8,10,11,[21][22][23] ; however, widespread adoption is limited by concerns regarding its specificity and cost efficacy, with an upfront device cost of roughly $250,000 and per-use cost of $650. 10,24 Our study serves as an important proof of concept for the use of NIRS, and specifically the ViOptix Intra.Ox, in bowel.…”

“…Preliminary studies have evaluated this technology in a variety of settings 3,8,10,11,[21][22][23] ; however, widespread adoption is limited by concerns regarding its specificity and cost efficacy, with an upfront device cost of roughly $250,000 and per-use cost of $650. 10,24 Our study serves as an important proof of concept for the use of NIRS, and specifically the ViOptix Intra.Ox, in bowel. The output of the Intra.Ox is reported as composite tissue oxygenation, derived from blood, both arterial and venous, encompassed within the photon visitation depth of the device (approximately 1 mm for the Intra.Ox).…”

“…Kalamazoo, MI) and PINPOINT Endoscopic Fluorescence Imagining System 3 (Stryker Co, Kalamazoo, MI) use a near infrared sensor to detect intravenously injected indocyanine green (ICG) dye within target tissue. However, the use of these dye-based systems has yet to be validated on a large scale, 10,12,13 and may come with the added cost of adverse patient reactions, 10,14 increased health care expenditure, 10 and overexcision of healthy tissue. 10 Near infrared spectroscopy offers a promising alternative to dye-based angiography techniques.…”

“…However, the use of these dye-based systems has yet to be validated on a large scale, 10,12,13 and may come with the added cost of adverse patient reactions, 10,14 increased health care expenditure, 10 and overexcision of healthy tissue. 10 Near infrared spectroscopy offers a promising alternative to dye-based angiography techniques. Handheld devices like the ViOptix Intra.Ox (ViOptix, Inc., Fremont, CA) measure the ratio of oxygenated to deoxygenated hemoglobin within target tissue without the need of intravenous dyes or cumbersome imaging machinery.…”

“…15 The Intra.Ox is wireless, battery operated, and allows for rapid, serial measurements throughout the procedure at a lower per-use cost than existing angiography systems. 10 Despite a growing body of evidence surrounding the Intra.Ox, to date there is no headto-head comparison of this technology with others. In this study, we aimed to use a porcine bowel model to directly compare perfusion assessment with the SPY Elite fluorescence imagining system and ViOptix Intra.Ox handheld tissue oximeter.…”