The Use of Portable Visible Light Hyperspectral Imaging (VL-HSI) in Assessing Random Pattern Flaps in the Setting of Breast Reconstruction
Victoria Prete BS1, SeungJu Oh BA1, Melissa McCarthy MD1, Robert Slamin MD1, Angel Baez MS2, John Castle MD2, Mustafa Akyurek MD PhD2, Janice Lalikos MD2
1University of Massachusetts Medical School, Worcester, MA, 2University of Massachusetts Medical School, Division of Plastic Surgery, Worcester, MA
Background: Breast reconstruction following mastectomy is often an important step in the treatment of those with or at high risk of breast cancer. Mastectomy skin flap necrosis has been reported as high as 10-30% in the literature. This represents an underappreciated problem that leads to significant morbidity in patients undergoing breast reconstruction. While several imaging modalities have been employed in the setting of flap monitoring none have proven consistently and universally effective. Visible Light Hyperspectral Imaging (VL-HSI), has shown great promise in assessing flap perfusion intra- and post-operatively. This prospective analysis aims to establish the utility of VL-HSI in the setting of random pattern flap monitoring following breast reconstruction and to establish normative VL-HSI parameters for nipple and breast tissue.
Methods: Twenty-one patients with thirty-five breasts undergoing random pattern mastectomy skin flaps were included in the study. Images were taken at six different time points using the HyperViewTM system: pre-operation (baseline), post-operative day (POD) 0, POD1, POD2, POD14, and POD30. Perfusion data obtained from the device was measured as oxygenated hemoglobin (OxyHb) and deoxygenated hemoglobin (DeoxyHb), and percentage O2 sat. We analyzed values at four zones within the surgical site: 0-10mm and 10-20mm areas, above and below the suture line.
Results: Average age of participants was 48.1 (?11.6). Baseline values of the breast showed a significant difference (p < 0.01) between OxyHb and DeoxyHb values at the nipple, 50.7 and 45.2 respectively, and the surrounding tissue, 45.2 and 34.8 respectively. Statistical analysis of the three postoperative perfusion parameters showed: a statistically significant (p<0.001) increase in OxyHb at POD0 with a wider variation in OxyHb values and a return to baseline by POD30. DeoxyHb showed no significant variation across time points. Oxygen saturation showed a significant increase from baseline to POD0 (p of <0.001) followed by a gradual decrease and return to baseline by POD14.
Conclusion:: VL-HSI has promising utility in the field of plastic surgery as a safe, effective, and non-invasive method of evaluating tissue perfusion status intra-operatively and post-operatively. This is the first study to help understand its potential clinical utility in random-pattern flaps in the setting of breast reconstruction. Analysis of tissue perfusion using VL-HSI revealed an increase in post-operative levels of OxyHb and O2 sat in the immediate post-operative period with a return to baseline by one-month post-op. We also established normative VL-HSI OxyHb and DeoxyHb values for both breast and nipple tissue.
Back to 2021 Abstracts