Perfusion in free breast reconstruction flap zones assessed with positron emission tomography

Abstract

The aim of this pilot study was to determine the postoperative blood perfusion (BF(PET)) and perfusion heterogeneity (BF(PET) HG) in free microvascular breast reconstruction flap zones with positron emission tomography (PET). Regional BF(PET) and BF(PET) HG of the adipose tissue in medial, central, and lateral parts of 13 free flaps were assessed on the first postoperative morning with PET using oxygen-15-labeled water ([(15)O]H(2)O) in 12 patients undergoing breast reconstruction with a deep inferior epigastric perforator (DIEP) or a transverse rectus abdominis muscle (TRAM) flap. The mean BF(PET) values did not differ between DIEP and TRAM flaps (P = 0.791). The mean BF(PET) values were higher in zone III compared with zone I (P = 0.024). During follow-up, fat necrosis was identified in three patients in the medial part (zone II) of the flap. However, the adipose tissue BF(PET) assessed on the first postoperative day from all zones of the flap using PET with radiowater was normal. The BF(PET) HG was higher in the control side (i.e., in the healthy breast tissue) compared with the flap (P = 0.042). The BF(PET) HG was lower in zone III than in zone I (P = 0.03) and in zone II (P < 0.001). In this pilot study, PET was used for the first time for studying the adipose tissue perfusion in different zones in free flaps in a clinical setup, finding that the mean BF(PET) values did not differ between DIEP and TRAM flaps, and that zone II was sometimes not as well perfused as zone III supporting revisited zone division.

Effects of Obesity on Postoperative Complications After Breast Reconstruction Using Free Muscle-Sparing Transverse Rectus Abdominis Myocutaneous, Deep Inferior Epigastric Perforator, and Superficial Inferior Epigastric Artery Flap

“…Among these, 15 presented data for msTRAM, DIEP, or SIEA flaps, and 8 of these 15 described complication rates for both obese and nonobese patients and thus were considered for estimating the RR 20,21,23,[25][26][27][28][29] (Table 1). Four studies presented data only for DIEP flaps 20,21,28,29 ; 3, for msTRAM and DIEP flaps [25][26][27] ; and 1, for msTRAM, DIEP, and SIEA flaps. 23 These studies were also included for the summarization of pooled complication rates except for 1 with fewer than 10 patients in each subgroup.…”

Perfusion of the diep flaps: A systematic review with meta‐analysis

“…Seven studies measured flap perfusion intraoperatively, or 1 day postoperatively . Relatively consistent results were observed in which zone I showed the highest value, followed by zones III, II, and IV, regardless of the perfusion index used (Table ).…”

“…A total of 835 publications were identified in the initial search. After reviewing the articles against the predefined selection criteria, 21 studies were analyzed (Fig. ).…”

“…The anatomical characteristics of the perforators and their linking vessels were described in nine studies . The results of ex‐vivo perfusion experiments were reported in eight studies, and those of clinical perfusion were reported in nine studies …”

“…Relatively consistent results were observed in which zone I showed the highest value, followed by zones III, II, and IV, regardless of the perfusion index used (Table ). Five studies representing 84 DIEP flaps provided mean and standard deviation data for each perfusion index, which allowed for a meta‐analysis. As each variable had a different scale, the standardized mean difference with 95% confidence intervals was calculated using inverse variance.…”