Prediction of post-operative necrosis after mastectomy: A pilot study utilizing optical diffusion imaging spectroscopy

Abstract

IntroductionFlap necrosis and epidermolysis occurs in 18-30% of all mastectomies. Complications may be prevented by intra-operative detection of ischemia. Currently, no technique enables quantitative valuation of mastectomy skin perfusion. Optical Diffusion Imaging Spectroscopy (ViOptix T.Ox Tissue Oximeter) measures the ratio of oxyhemoglobin to deoxyhemoglobin over a 1 × 1 cm area to obtain a non-invasive measurement of perfusion (StO2).MethodsThis study evaluates the ability of ViOptix T.Ox Tissue Oximeter to predict mastectomy flap necrosis. StO2 measurements were taken at five points before and at completion of dissection in 10 patients. Data collected included: demographics, tumor size, flap length/thickness, co-morbidities, procedure length, and wound complications.ResultsOne patient experienced mastectomy skin flap necrosis. Five patients underwent immediate reconstruction, including the patient with necrosis. Statistically significant factors contributing to necrosis included reduction in medial flap StO2 (p = 0.0189), reduction in inferior flap StO2 (p = 0.003), and flap length (p = 0.009).ConclusionStO2 reductions may be utilized to identify impaired perfusion in mastectomy skin flaps.

Systematic review of methodologies used to assess mastectomy flap viability

“…1). After detailed examination of 30 full‐text articles, 18 studies7 19, 20 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, including 2077 patients, were included in this review.…”

“…One was to compare rates of mastectomy necrosis and other complications, such as reoperation rates, and clinical outcomes between the techniques used ( Table 1). Seven case series7 28, 29, 30, 31, 32 34 and one cohort study33 used this approach. The alternative approach in seven prospective cohort studies19 20, 35, 36, 37, 38, 39 was to evaluate flap perfusion using the intraoperative modalities and to record the predicted areas of necrosis using photographic documentation or video recording.…”

“…Mastectomy flap necrosis rates were compared with clinical judgement in seven7 28, 29, 30, 31, 32, 33 studies using ICGA, one study using FA33 and one pilot study using ODIS34. Use of ICGA in 652 and FA in 34 breasts resulted in a decrease in mean mastectomy flap necrosis compared with clinical judgement in 1964 breasts (7·9 and 3 compared with 19·4 per cent) ( Table 3).…”

“…Use of ICGA in 652 and FA in 34 breasts resulted in a decrease in mean mastectomy flap necrosis compared with clinical judgement in 1964 breasts (7·9 and 3 compared with 19·4 per cent) ( Table 3). Use of ODIS in five patients resulted in a mastectomy flap necrosis rate of 20 per cent34. Studies varied in their classification of skin necrosis; some did not offer a definition, whereas others30 32, 35 used a scoring system such as mild, moderate or severe, with a description of what was meant by these terms.…”

“…The use of ODIS was associated with a reoperation rate of 20 per cent34. Rate of reoperation owing to direct causes of mastectomy flap necrosis was extracted when possible, but in cases of ambiguity reoperation for overall complications was used to calculate the mean rate ( Table 2).…”