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Intraoperative laser speckle contrast imaging in DIEP breast reconstruction : a prospective case series study

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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.
Keywords
MICROCIRCULATORY EVALUATION, INDOCYANINE GREEN, BLOOD-FLOW, FLAP, PERFUSION, TRAM

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MLA
Zotterman, Johan, et al. “Intraoperative Laser Speckle Contrast Imaging in DIEP Breast Reconstruction : A Prospective Case Series Study.” PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN, vol. 8, no. 1, 2020, doi:10.1097/GOX.0000000000002529.
APA
Zotterman, J., Opsomer, D., Farnebo, S., Blondeel, P., Monstrey, S., & Tesselaar, E. (2020). Intraoperative laser speckle contrast imaging in DIEP breast reconstruction : a prospective case series study. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN, 8(1). https://doi.org/10.1097/GOX.0000000000002529
Chicago author-date
Zotterman, Johan, Dries Opsomer, Simon Farnebo, Phillip Blondeel, Stan Monstrey, and Erik Tesselaar. 2020. “Intraoperative Laser Speckle Contrast Imaging in DIEP Breast Reconstruction : A Prospective Case Series Study.” PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 8 (1). https://doi.org/10.1097/GOX.0000000000002529.
Chicago author-date (all authors)
Zotterman, Johan, Dries Opsomer, Simon Farnebo, Phillip Blondeel, Stan Monstrey, and Erik Tesselaar. 2020. “Intraoperative Laser Speckle Contrast Imaging in DIEP Breast Reconstruction : A Prospective Case Series Study.” PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 8 (1). doi:10.1097/GOX.0000000000002529.
Vancouver
1.
Zotterman J, Opsomer D, Farnebo S, Blondeel P, Monstrey S, Tesselaar E. Intraoperative laser speckle contrast imaging in DIEP breast reconstruction : a prospective case series study. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN. 2020;8(1).
IEEE
[1]
J. Zotterman, D. Opsomer, S. Farnebo, P. Blondeel, S. Monstrey, and E. Tesselaar, “Intraoperative laser speckle contrast imaging in DIEP breast reconstruction : a prospective case series study,” PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN, vol. 8, no. 1, 2020.
@article{8692268,
  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.}},
  articleno    = {{e2529}},
  author       = {{Zotterman, Johan and Opsomer, Dries and Farnebo, Simon and Blondeel, Phillip and Monstrey, Stan and Tesselaar, Erik}},
  issn         = {{2169-7574}},
  journal      = {{PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN}},
  keywords     = {{MICROCIRCULATORY EVALUATION,INDOCYANINE GREEN,BLOOD-FLOW,FLAP,PERFUSION,TRAM}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{7}},
  title        = {{Intraoperative laser speckle contrast imaging in DIEP breast reconstruction : a prospective case series study}},
  url          = {{http://dx.doi.org/10.1097/GOX.0000000000002529}},
  volume       = {{8}},
  year         = {{2020}},
}

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