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. 2022 May 1;12(5):740.
doi: 10.3390/jpm12050740.

Assessment of Mastectomy Skin Flaps for Immediate Reconstruction with Implants via Thermal Imaging-A Suitable, Personalized Approach?

Hanna Luze  1 , Sebastian Philipp Nischwitz  1 , Paul Wurzer  1   2 , Raimund Winter  1 , Stephan Spendel  1 , Lars-Peter Kamolz  1   3   4 , Vesna Bjelic-Radisic  5   6
Affiliations

Assessment of Mastectomy Skin Flaps for Immediate Reconstruction with Implants via Thermal Imaging-A Suitable, Personalized Approach?

Hanna Luze et al. J Pers Med. .

Abstract

Background: Impaired perfusion of the remaining skin flap after subcutaneous mastectomy can cause wound-healing disorders and consecutive necrosis. Personalized intraoperative imaging, possibly performed via the FLIR ONE thermal-imaging device, may assist in flap assessment and detect areas at risk for postoperative complications.

Methods: Fifteen female patients undergoing elective subcutaneous mastectomy and immediate breast reconstruction with implants were enrolled. Pre-, intra- and postoperative thermal imaging was performed via FLIR ONE. Potential patient-, surgery- and environment-related risk factors were acquired and correlated with the occurrence of postoperative complications.

Results: Wound-healing disorders and mastectomy-skin-flap necrosis occurred in 26.7%, whereby areas expressing intraoperative temperatures less than 26 °C were mainly affected. These complications were associated with a statistically significantly higher BMI, longer surgery duration, lower body and room temperature and a trend towards larger implant sizes.

Conclusion: Impaired skin-flap perfusion may be multifactorially conditioned. Preoperative screening for risk factors and intraoperative skin-perfusion assessment via FLIR ONE thermal-imaging device is recommendable to reduce postoperative complications. Intraoperative detectable areas with a temperature of lower than 26 °C are highly likely to develop mastectomy-skin-flap necrosis and early detection allows individual treatment concept adaption, ultimately improving the patient's outcome.

Keywords: mastectomy-skin-flap necrosis; mastectomy-skin-flap perfusion; personalized medicine; reconstructive breast surgery; thermal imaging.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Intraoperative thermal imaging via FLIR ONE. The ROI (black circle) displays the subcutaneous mastectomy area, within the temperature was measured. Darker colors (purple, blue) indicate lower surface temperature while brighter colors (orange, yellow) indicate higher temperature.
Figure 2
Figure 2
Surface temperature changes during the procedure of NSM/SSM and immediate reconstruction with implants. Data are presented as mean values [°C].
Figure 3
Figure 3
Incision types and postoperative complications. Abbreviations: Mastectomy-skin-flap necrosis (MSFN); wound-healing disorder (WHD).
See this image and copyright information in PMC

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