Technical difficulties and key points of DIEP in breast reconstruction / 中华内分泌外科杂志

Surgical treatment is an important part of comprehensive management for breast cancer patients. Loss of breast will bring serious psychological trauma to patients and greatly reduce the quality of life. In autologous breast reconstruction, deep inferior epigastric artery perforator flap (DIEP) -a representative reconstructive technology has its incomparable advantages. The flap has sufficient blood supply. The reconstructed breast has natural contour and texture, and the complications in the donor area were quite low. It is also an important alternative to rescue the reconstructive failures. However, DIEP flap is difficult and has a long learning curve. The key technical points and difficulties not only run through the whole process of operation, but also exist before and after operation. On the basis of mastering the main concepts of DIEP, this paper would elaborate the important details in the operation process and emphasize the monitoring of skin flap after operation and the corresponding plan. This will help to better popularize the operation technique, improve the success rate of operation and patient satisfaction, while reduce operative complications and benefit more breast cancer patients.

The use of laser speckle contrast imaging in clinical applications

Laser speckle contrast imaging (LSCI) is a useful device which is recruited for visualizing full-field microcirculatory images. The speckle pattern is produced as a consistent light illuminates a rough object, and the backscattered radiation is transformed into images and be shown on a screen. Movement within the object results in the fluctuation of patterns over time. Similar information can be attained by employing the Doppler effect, which needs to be scanned again. However, LSCI renders similar data without any further scanning procedure. Nowadays, LSCI has gained expanded consideration, in part because of its accelerated adoption for blood flow studies in the different surgical departments. Here we represent and review the application of LSCI methods of visualizing the field of microcirculation as medical applications from different clinical aspects and discuss the drawbacks that hinder its approval clinically

Retracted: A review of the clinical applications and performance of laser speckle contrast imaging

Laser speckle contrast imaging (LSCI) is a useful tool for visualizing full-field blood flow images. Speckle pattern is formed when a coherent light illuminates a rough object, and the backscattered radiation is transformed into images and be shown on a screen. Movement within the object results in the fluctuation of patterns over time. The same data can be obtained by employing the Doppler effect, yet producing a two-dimensional Doppler map needs scanning;speckle imaging renders the same information without the requirement to scan. Nowadays, LSCI has gained expanded consideration, in part because of its accelerated adoption for blood flow studies in the different surgical departments. Here we represent and review the application of laser speckle contrast methods to the field of perfusion visualization as clinical studies from various medical fields and discuss the limitations hindering clinical acceptance

Estableciendo protocolo de apoyo en microcirugía / Developing a protocol to support microsurgery

Microsurgery is a developing technique in our setting, and it’s success can be related to elements that are not related to the surgeon. Because of this, the Plastic Surgery Team in the Chilean Airforce Hospital has become aware of the need to develop a support protocol for microsurgery, which can be used in any setting throughout our country. It’s focus is set in optimizing and controlling physiological and anesthetic variables, and those not related to the technique itself, which can influence the microsurgery outcome and the patients perioperative morbi-mortality.

La microcirugía es una técnica en pleno desarrollo en nuestro medio y su éxito puede estar condicionado a veces a elementos externos al cirujano. Es por esto que, en el Hospital de la Fuerza Aérea de Chile, el Equipo de Cirugía Plástica ha notado la necesidad de diseñar un protocolo de apoyo a la microcirugía, el cual sea posible implementar en cualquier medio nacional. Su enfoque está dirigido a optimizar y controlar las variables fisiológicas, anestésicas y externas a la técnica quirúrgica en si misma, que podrían incidir en el éxito de la microcirugía como en la morbimortalidad perioperatoria de los pacientes.

Application of Digital Infrared Thermographic Imaging (DITI) in the Monitoring of Change of Skin Temperature about Vascular Supply of Lower Abdominal Axial Flap in the Rabbit / 고신대학교의과대학학술지

OBJECTIVES: Monitoring viability of flap is important. The flap survival depends on the vascularity of the flap, on which the skin temperature depends. The authors applied digital infrared thermographic imaging (DITI) for monitoring the vascular supply of the flap and for the prediction of the prognosis of the flap survival. METHODS: Eight male New Zealand white rabbits with average weight of 3kg were used. A 10 x 10 cm unipedicled fasciocutaneous island flap was elevated based on the left superficial inferior epigastric vessel. The surface temperatures on designed flap were checked with DITI for 24 hours after the operation. On 14th day after the operation, the surviving area was measured and compared with DITI image which was taken on 24 hours after the operation using digital analysis software ImageJ. Statistical analysis was evaluated by paired T-test. RESULTS: On DITI image 24 hours after the flap elevation, distal portion of the flap showed remarkable color change. The average percentage and the standard deviation of the survival area of the flap which is predicted by DITI and the average percentage and the standard deviation of the survival area of the flap which was actually measured 2 weeks after flap elevation were 55.3 (16.6), 56.2 (18.0), respectively. This shows no significant difference between the two. CONCLUSIONS: This study shows that DITI system could be used in evaluation of flap vascularity with ease, quickness and safety for patient and flap. Thus, it could be used clinically for the prediction of flap survival.

Modified Design of Anterolateral Thigh Free Flap for Hypopharyngeal Reconstruction

PURPOSE: Defect after ablation of hypopharyngeal cancer often requires reconstruction by free tissue transfer. Since neo-hypopharynx is totally buried, various methods have been suggested for monitoring. We propose a modified design of anterolateral thigh (ALT) free flap for reconstruction of pharyngolaryngectomy defect, which has an exteriorized part for clinical monitoring and allows for primary closure. MATERIALS AND METHODS: Three consecutive patients with hypopharyngeal cancer were reconstructed with ALT flap with modified design: 1) distal part of flap was elongated into fusiform shape and used as exteriorized monitoring segment with a deepithelized bridge and 2) proximal part was designed as curve so the maximum width of the flap was reduced to less than 10 cm. RESULTS: Patient 1, 2 had uneventful postoperative course with healthy skin color and fresh pin prick bleeding. In patient 3, defect after cancer ablation was shorter than usual and deepithelized bridge was longer. When the general hemodynamic status of the patient was aggravated in postoperative course, the color of monitoring skin was changed. Viability of the whole flap was confirmed by endoscopy. However, leakage developed after 3 weeks and repair was necessary. In all patients the donor sites were closed primarily. CONCLUSION: By the modified design of ALT flap, clinical monitoring can be possible by examining exteriorized monitoring flap and also donor site can be closed primarily. However possibility of false positive exists and technical caution and patient selection is needed because of danger of leakage.

Application of ThermalCAMTM P40-Infrared Thermographic Imaging in the Monitoring of Survival of Lower Abdominal Random Flap in the Rabbit

The monitoring of viability of the flap is important in improvement of the flap survival. The flap survival depends on the vascularity of the flap, and the skin temperature is up to the vascularity. The authors applied ThermalCAMTM P40 infrared thermographic imaging system for the monitoring of the vascular supply of the flap. The various sized flaps are designed on the lower abdomen of rabbit, having expected risk rate of flap necrosis respectively. The surface temperatures on designed flap were checked with ThermalCAMTM P40 before flap elevation and after respectively. The flaps with high risk of necrosis, 1:4(width/length) designed flaps and some 1:3 flaps, showed remarkable color change in distal portion according to difference of surface temperatures. After 1 week, the flaps of lower abdomen showed different viability of flap, and the flap with remarkable color change showed partial necrosis distally. The Necrotic areas were identical with the color change area checked with ThermalCAMTM P40. This study shows that ThermalCAMTM P40 infrared thermographic imaging system has the utility in prediction on flap survival through detection of the vascularity with ease, quickness and safety for patient and flap.

Utility of Laser Doppler Flowmetry in Postoperative Monitoring of Free Flap

Continuous observation based on the operator's clinical experience is impractical in monitoring free flap and the success rate of flap can be increased with the adjunctive monitoring system such as laser Doppler flowmetry. The author tried to establish the objective critical point to analyze the data in the postoperative period in microsurgical reconstruction. In this study, laser Doppler flowmetry(Periflux 4001 Master , Sweden) was used continuously for flap monitoring from the recovery room; every hour for 24hours, every 2 hours in the next 24 hours and every 3 - 6hours thereafter until the 7th day. Among 43 cases performed, 4 patients suffered from postoperative vascular insufficiency and they were decided to follow the exploration or salvage procedure. The value may be recorded at most 3.0 even when the tissue sufferes without flow due to its highly sensitive system, and it is quite reliable for flap survival if the initial value is above 3.0 with increasing trend. If the flow value persists below 3.0 continuously or show a plateau, vascular compromise can be doubted. Initial plateau or decline curve was caused by flap swelling and could be detected in 2 postoperative periods such as early (2-24hour) and /or late (26 -116 hour) period. Its decline was maximally up to 31.5% and this decline was more commonly observed in perforator- based free flap than others. However, its appearance and duration was quite unexpected especially in small free flap due to skin tension after suture. In conclusion, the laser Doppler flowmetry is a valuable adjunctive system in flap monitoring after operation by observing the trend in perfusion value.