Adequate tissue perfusion is essential to minimize postoperative complications following microsurgery. Intraoperative knowledge of tissue perfusion could aid surgical decision-making and result in reduced complications. Laser speckle imaging is a new, noninvasive technique for mapping tissue perfusion. This article discusses the feasibility of using laser speckle imaging during free flap breast reconstruction and its potential to identify areas of inadequate perfusion, thus reducing surgical complications. Adult patients scheduled to undergo free flap breast reconstruction were recruited into the study. Laser speckle images were obtained from the abdominal and breast areas at different stages intraoperatively. Zonal perfusion was compared with the Holm classification and clinical observations. Twenty patients scheduled to undergo free flap breast reconstruction were recruited (23 reconstructed breasts) (mean age, 50 years; range, 32 to 68 years). Flap zonal perfusion was 238 (187 to 313), 222 (120 to 265), 206 (120 to 265), and 125 (102 to 220) perfusion units for zones I, II, III, and IV, respectively (analysis of variance, p < 0.0001). Zonal area with perfusion below an arbitrary perfusion threshold were 20 (0.3 to 75), 41 (3 to 99), 49 (9 to 97), and 99 (25 to 100) percent, respectively (analysis of variance, p < 0.0001). One example is presented to illustrate potential intraoperative uses for laser speckle imaging. This study shows that laser speckle imaging is a feasible, noninvasive technique for intraoperative mapping of tissue perfusion during free flap breast reconstruction. Zonal tissue perfusion was reduced across the Holm classification. Observations indicated the potential for laser speckle imaging to provide additional information to augment surgical decision-making by detection of inadequate tissue perfusion. This highlights the opportunity for surgeons to consider additional aids for intraoperative tissue perfusion assessment to help reduce perfusion-related complications.
Exeter and Torquay, Devon, United Kingdom
From the Diabetes and Vascular Medicine Research Centre, NIHR Exeter Clinical Research Facility, University of Exeter Medical School; the Breast Care Unit, Torbay and South Devon NHS Foundation Trust, Torbay Hospital; the Department of Plastic Surgery, Royal Devon and Exeter NHS Foundation Trust; and Moor Instruments.
Received for publication July 10, 2017; accepted August 2, 2018.
The authors listed first and second are co–first authors.
Disclosure: This study was funded in part by Technology Strategy Board (now, Innovate UK) (Ref: 131268) and equipment was provided by Moor Instruments Ltd. Dr. Gush is employed by Moor Instruments Ltd. No other authors have any conflicts of interest or financial interests in any of the products or devices mentioned in this article.
Supplemental digital content is available for this article. Direct URL citations appear in the text; simply type the URL address into any Web browser to access this content. Clickable links to the material are provided in the HTML text of this article on the Journal’s website (www.PRSJournal.com).
Cynthia To, M.Sc., Diabetes and Vascular Medicine Research Centre, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Devon EX2 5AX, United Kingdom, firstname.lastname@example.org, Twitter: @Cynthiato_