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Novel tool seen as promising for assessment of mastectomy skin flaps

A noncontact, diffuse correlation spectroscopy device provided objective information about the viability of mastectomy skin flaps, which can allow surgeons to identify compromised and ischemic flaps early, and potentially save these structures, according to researchers from the University of Kentucky.

“Mastectomy skin flap necrosis, infection and implant loss are all interlinked by a shortfall of blood flow/issue perfusion at the microcirculatory level,” Nneamaka B. Agochukwu, MD, the lead author, and colleagues wrote in Plastic and Reconstructive Surgery. “Current approaches to detect mastectomy skin flap necrosis include clinical assessment, fluorescein dye angiography and indocyanine green dye angiography. Clinical assessment has been shown to be inherently unreliable because of this lack of objectivity.”

To judge the use of the noncontact, diffuse correlation spectroscopy device in the prediction of mastectomy skin flap necrosis, the researchers recruited 19 women who were undergoing mastectomy and subsequent implant-based breast reconstruction. Researchers used the noncontact, diffuse correlation spectroscopy device to measure mastectomy skin flap blood flow following implantation of the prosthesis the prostheses were implanted.

The patients were observed for complications, such as skin necrosis and the need for further surgery. Overall, four patients developed skin necrosis and one such patient required additional surgery.

Researchers found the difference in relative blood flow levels immediately following mastectomy between patients with vs. those without necrosis was statistically significant. In addition, relative blood flow measurements taken immediately after mastectomy demonstrated a “significant high accuracy” in predicting skin flap necrosis, the researchers wrote.

“Our pilot study demonstrated the feasibility of noncontact diffuse correlation spectroscopy for the perioperative monitoring of blood flow variations in mastectomy skin flap necrosis,” Agochukwu and colleagues wrote. “Further studies will provide the rationale and framework needed for designing optical image-guided clinical trials for breast reconstruction and the application of this technology to other clinical uses, including wound care and burns.”

References:

Agochukwu NB, et al. Plast Reconstr Sug. 2017;doi: 10.1097/PRS.0000000000003415.

www.journals.lww.com/plasreconsurg/Abstract/2017/07000/A_Novel_Noncontact_Diffuse_Correlation.5.aspx

Disclosures: The researchers report no relevant financial disclosures.

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