Moritz William R, Daines John, Christensen Joani M, Myckatyn Terence, Sacks Justin M, Westman Amanda M
From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo.
Plast Reconstr Surg Glob Open. 2023 Jul 11;11(7):e5113. doi: 10.1097/GOX.0000000000005113. eCollection 2023 Jul.
In breast reconstruction, mastectomy and free flaps are susceptible to vascular compromise and tissue necrosis. The SnapshotNIR device (Kent Imaging, Calgary, AB, Canada) utilizes near-infrared spectroscopy to measure tissue oxygen saturation (StO) and hemoglobin concentration. Here, we report on the use of this device for StO monitoring among patients receiving alloplastic or autologous breast reconstruction.
Patients receiving immediate alloplastic reconstruction after mastectomy or autologous reconstruction were enrolled. Preoperative, intraoperative, and postoperative images were taken of the flaps. StO and hemoglobin were measured at the following locations: superior and inferior breast, free flap skin paddle (when applicable), and un-operated control skin. Linear mixed effects model for repeated measurements was used to model measurements to estimate the area effect difference across time, time effect difference across area, and pairwise comparisons between two areas at each time point.
Thirty-two breasts underwent alloplastic reconstruction; 38 breasts underwent autologous reconstruction. No enrollees developed skin necrosis. StO was highest after mastectomy and closure in alloplastic reconstructions. StO was observed to decline at follow-up in autologous reconstructions. Mean preoperative StO was highest in breasts that had previously undergone mastectomy and alloplastic reconstruction.
The SnapshotNIR device detected normal spatial and temporal differences in tissue oxygenation over the operative course of alloplastic and autologous breast reconstruction. A multi-institutional, prospective clinical trial is needed to determine the sensitivity and specificity of this device for detecting skin flap necrosis.
在乳房重建中，乳房切除术和游离皮瓣易出现血管受损和组织坏死。SnapshotNIR设备（加拿大艾伯塔省卡尔加里市的肯特成像公司）利用近红外光谱法测量组织氧饱和度（StO）和血红蛋白浓度。在此，我们报告该设备在接受异体或自体乳房重建患者中的StO监测应用情况。
纳入乳房切除术后立即进行异体重建或自体重建的患者。对皮瓣进行术前、术中和术后成像。在以下部位测量StO和血红蛋白：乳房上、下区域，游离皮瓣皮瓣（如适用），以及未手术的对照皮肤。采用重复测量的线性混合效应模型对测量值进行建模，以估计不同时间的区域效应差异、不同区域的时间效应差异以及每个时间点两个区域之间的成对比较。
32个乳房接受了异体重建；38个乳房接受了自体重建。没有受试者发生皮肤坏死。在异体重建中，乳房切除术后及关闭切口后StO最高。在自体重建中，随访时观察到StO下降。先前接受过乳房切除术和异体重建的乳房术前平均StO最高。
SnapshotNIR设备在异体和自体乳房重建的手术过程中检测到了组织氧合的正常空间和时间差异。需要进行一项多机构的前瞻性临床试验来确定该设备检测皮瓣坏死的敏感性和特异性。
