Non-invasive tissue oximetry following unilateral DIEP-flap reconstruction: A pilot evaluation

Vranken, Nousjka P.A.; Weerwind, Patrick W.; Onna, Martijn A. van; Bouman, Esther; Hulst, René R W J van der

doi:10.1016/j.jpra.2017.01.008

Cited by 9 publications

(9 citation statements)

References 16 publications

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“…In these studies, no particular definition of a false-positive result was given. Vranken et al 38 and Rothenberg et al 36 did not provide false-positive results; however, their high specificities suggest low false-positive rates. In addition, Pelletier et al 34 advocate that the use of NIRS devices can reduce the FTT monitoring cost structure.…”

Section: Discussionmentioning

confidence: 94%

Use of Near-infrared Spectroscopy and Implantable Doppler for Postoperative Monitoring of Free Tissue Transfer for Breast Reconstruction: A Systematic Review and Meta-analysis

Berthelot

Ashcroft

Boshier

et al. 2019

Plastic and Reconstructive Surgery - Global Open

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Section: Discussionmentioning

confidence: 94%

Use of Near-infrared Spectroscopy and Implantable Doppler for Postoperative Monitoring of Free Tissue Transfer for Breast Reconstruction: A Systematic Review and Meta-analysis

Berthelot

Ashcroft

Boshier

et al. 2019

Plastic and Reconstructive Surgery - Global Open

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“…During early postoperative recovery, it appeared that blood flow towards the caudal side of the left flap was impeded, for which revisional surgery was required to allow tissue salvage. On the fifth [6,17,22] which suggested that postoperative StO 2 readings could identify vascular compromise in an early postoperative phase.…”

Section: Resultsmentioning

confidence: 99%

Exploring personalized postoperative non-invasive tissue oximetry in DIEP flap breast reconstruction

et al. 2021

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Early detection of vascular compromise after autologous breast reconstruction is crucial to enable timely re-exploration for flap salvage. Several studies proposed non-invasive tissue oximetry for early identification of ischemia of deep inferior epigastric perforator (DIEP) flaps. The present study aimed to explore the utility of non-invasive tissue oximetry following DIEP flap surgery using a personalized oxygenation threshold. Methods Patients undergoing immediate/delayed DIEP flap surgery were included in this prospective observational study. DIEP flap tissue oxygenation (StO2) was monitored continuously using near-infrared spectroscopy. A baseline measurement was performed by positioning one sensor at the marked position of the major inferior epigastric perforator on the abdomen. A new sensor was positioned postoperatively on the transplanted tissue. In unilateral procedures, postoperative StO2 values of the native breast were also obtained. Measurements were continued for 24 h. Results Thirty patients (42 flaps) were included. Fourteen patients (46.7%) had an uncomplicated postoperative course. A minor complication was observed in thirteen patients; in five patients, at least one major complication occurred, requiring re-exploration. Median StO2 readings were significantly lower in patients with major complications compared to uncomplicated cases. In fourteen unilateral DIEP flap procedures, StO2 values of the native breast were similar to the preoperative baseline measurement (92%; p = 0.452). Conclusions Non-invasive tissue oximetry following DIEP flap surgery could aid in early detection of vascular compromise. StO2 values of the native breast and abdominal wall preoperatively can be used interchangeably and can serve as personalized reference value. Level of evidence: Level IV, diagnostic / prognostic study.

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“…Hypoxia is a process simultaneous with breast reconstruction. Flaps which are supplied solely by their anastomoses have graft borders which are not immediately supplied by native, ingrowing vessels [ 73 ]. Implants and expanders exert pressure on the breast boundaries, which decreases microvasculature efficiency, leading to hypoxia [ 74 ].…”

Section: Which Factors May Drive Recurrence?mentioning

confidence: 99%

Breast cancer recurrence after reconstruction: know thine enemy

et al. 2018

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Breast reconstruction proceeding cancer treatment carries risk, regardless of the type of surgery. From fat grafting, to flap placement, to implants, there is no guarantee that reconstruction will not stimulate breast cancer recurrence. Research in this field is clearly divided into two parts: scientific interventional studies and clinical retrospective evidence. The reconstructive procedure offers hypoxia, a wound microenvironment, bacterial load, adipose derived stem cells; agents shown experimentally to cause increased cancer cell activity. This is compelling scientific evidence which serves to bring uncertainty and fear to the reconstructive procedure. In the absence of clinical evidence, this laboratory literature landscape is now informing surgical choices. Curiously, clinical studies have not shown a clear link between breast cancer recurrence and reconstructive surgery. Where does that leave us? This review aims to analyze the science and the surgery, thereby understanding the oncological fear which accompanies breast cancer reconstruction.

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Non-invasive tissue oximetry following unilateral DIEP-flap reconstruction: A pilot evaluation

Cited by 9 publications

References 16 publications

Use of Near-infrared Spectroscopy and Implantable Doppler for Postoperative Monitoring of Free Tissue Transfer for Breast Reconstruction: A Systematic Review and Meta-analysis

Use of Near-infrared Spectroscopy and Implantable Doppler for Postoperative Monitoring of Free Tissue Transfer for Breast Reconstruction: A Systematic Review and Meta-analysis

Exploring personalized postoperative non-invasive tissue oximetry in DIEP flap breast reconstruction

Breast cancer recurrence after reconstruction: know thine enemy

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