Abstract
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.MethodsPatients 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.ResultsThirty 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).ConclusionsNon-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.
Highlights
Advances in microsurgical techniques contributed to deep inferior epigastric perforator (DIEP) flap becoming the preferred choice of postmastectomy autologous breast reconstruction [1, 2]
The aim of the present study was to confirm the usefulness of non-invasive tissue oximetry in postoperative monitoring of DIEP flaps for autologous breast reconstruction, and to incorporate a personalized tissue oxygen threshold for more accurate interpretation of changes in StO2 values
Variables were presented as means ± standard deviation (SD) or median [interquartile range] (IQR)
Summary
Advances in microsurgical techniques contributed to deep inferior epigastric perforator (DIEP) flap becoming the preferred choice of postmastectomy autologous breast reconstruction [1, 2]. Postoperative (partial) flap compromise, for which immediate re-exploration is required to minimize the risk of flap loss, still occurs in 5–25% of the procedures [3, 6]. The time between the onset of malperfusion and surgical intervention is directly related to the salvage rate, and if re-exploration is not performed within 12 h, ischemic tissue damage is likely to be irreversible [6,7,8]. Total or partial loss of a DIEP flap. Early detection of vascular compromise, enabling timely re-exploration is crucial in preventing complications contributing to flap failure
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