D104. Use Of SPY-QP To Predict Mastectomy Skin Flap Wound Complications in Immediate Breast Reconstruction

Abstract

PURPOSE: SPY-QP® enables surgeons to assess relative perfusion quantitatively and in real-time; however, studies assessing its utility in predicting wound complications following breast reconstruction are limited. METHODS: Perfusion values were prospectively collected on patients undergoing staged breast reconstruction. There is currently no consensus on cut-off values for low perfusion, therefore the following values were used: 33% (reported by Moyer et al) and 30.0145% (calculated by the Youden index based on a logistic regression model). RESULTS: Twenty-four patients with 34 breasts underwent tissue expander (TE) placement at the time of mastectomy. SPY-QP was used after the TE was placed and filled with air to better reflect the postoperative state of the skin flaps. 4 breasts developed wound complications in areas with corresponding SPY-QP values of less than or equal to 30% (9.0-30.0%). The 33% cut-off yielded an odds ratio (OR) of 20.368 (95% CI: 0.9-450.7) for wound development, whereas the 30.0145% cut-off yielded an OR of 28.201 (95% CI: 1.3-632.8). When adjusted for nitroglycerin ointment usage, the OR was 16.827 (95% CI: 0.8-363.0), suggesting that it may interfere with wound development. CONCLUSION: SPY-QP® can safely predict wound development in breast reconstruction patients and guide clinical management of breast skin flaps. We suggest using a perfusion cut-off value of 30.0145%; however, larger, prospective studies are needed.