In-vivo quantitative evaluation of perfusion zones and perfusion gradient in the deep inferior epigastric artery perforator flap

Michel Saint-Cyr, Chrisovalantis Lakhiani, Angela Cheng, Michael Mangum, Jinyang Liang, Sumeet Teotia, Edward H. Livingston, Karel J. Zuzak

Research output: Chapter in Book/Report/Conference proceedingConference contribution

4 Citations (Scopus)

Abstract

The selection of well-vascularized tissue during DIEP flap harvest remains controversial. While several studies have elucidated cross-midline perfusion, further characterization of perfusion to the ipsilateral hemiabdomen is necessary for minimizing rates of fat necrosis or partial fat necrosis in bilateral DIEP flaps. Eighteen patients (29 flaps) underwent DIEP flap harvest using a prospectively designed protocol. Perforators were marked and imaged with a novel system for quantitatively measuring tissue oxygenation, the Digital Light Hyperspectral Imager. Images were then analyzed to determine if perforator selection influenced ipsilateral flap perfusion. Flaps based on a single lateral row perforator (SLRP) were found to have a higher level of hemoglobin oxygenation in Zone I (mean %HbO2 = 76.1) compared to single medial row perforator (SMRP) flaps (%HbO2 = 71.6). Perfusion of Zone III relative to Zone I was similar between SLRP and SMRP flaps (97.4% vs. 97.9%, respectively). These differences were not statistically significant (p>0.05). Perfusion to the lateral edge of the flap was slightly greater for SLRP flaps compared SMRP flaps (92.1% vs. 89.5%, respectively). SMRP flaps had superior perfusion travelling inferiorly compared to SLRP flaps (88.8% vs. 83.9%, respectively). Overall, it was observed that flaps were better perfused in the lateral direction than inferiorly. Significant differences in perfusion gradients directed inferiorly or laterally were observed, and perforator selection influenced perfusion in the most distal or inferior aspects of the flap. This suggests broader clinical implications for flap design that merit further investigation.

Original languageEnglish (US)
Title of host publicationProceedings of SPIE - The International Society for Optical Engineering
Volume8618
DOIs
StatePublished - 2013
EventEmerging Digital Micromirror Device Based Systems and Applications V - San Francisco, CA, United States
Duration: Feb 5 2013Feb 6 2013

Other

OtherEmerging Digital Micromirror Device Based Systems and Applications V
CountryUnited States
CitySan Francisco, CA
Period2/5/132/6/13

Fingerprint

Perforators
Quantitative Evaluation
Arteries
arteries
Gradient
Lateral
gradients
evaluation
Flaps
Necrosis
Oxygenation
Oils and fats
Hemoglobin
necrosis
oxygenation
fats
Fats
Imager
Tissue
Image sensors

Keywords

  • Deep inferior epigastric artery perforator flap
  • DIEP flap
  • Free flap
  • Hyperspectral
  • Tissue imaging

ASJC Scopus subject areas

  • Applied Mathematics
  • Computer Science Applications
  • Electrical and Electronic Engineering
  • Electronic, Optical and Magnetic Materials
  • Condensed Matter Physics

Cite this

Saint-Cyr, M., Lakhiani, C., Cheng, A., Mangum, M., Liang, J., Teotia, S., ... Zuzak, K. J. (2013). In-vivo quantitative evaluation of perfusion zones and perfusion gradient in the deep inferior epigastric artery perforator flap. In Proceedings of SPIE - The International Society for Optical Engineering (Vol. 8618). [861806] https://doi.org/10.1117/12.2004972

In-vivo quantitative evaluation of perfusion zones and perfusion gradient in the deep inferior epigastric artery perforator flap. / Saint-Cyr, Michel; Lakhiani, Chrisovalantis; Cheng, Angela; Mangum, Michael; Liang, Jinyang; Teotia, Sumeet; Livingston, Edward H.; Zuzak, Karel J.

Proceedings of SPIE - The International Society for Optical Engineering. Vol. 8618 2013. 861806.

Research output: Chapter in Book/Report/Conference proceedingConference contribution

Saint-Cyr, M, Lakhiani, C, Cheng, A, Mangum, M, Liang, J, Teotia, S, Livingston, EH & Zuzak, KJ 2013, In-vivo quantitative evaluation of perfusion zones and perfusion gradient in the deep inferior epigastric artery perforator flap. in Proceedings of SPIE - The International Society for Optical Engineering. vol. 8618, 861806, Emerging Digital Micromirror Device Based Systems and Applications V, San Francisco, CA, United States, 2/5/13. https://doi.org/10.1117/12.2004972
Saint-Cyr M, Lakhiani C, Cheng A, Mangum M, Liang J, Teotia S et al. In-vivo quantitative evaluation of perfusion zones and perfusion gradient in the deep inferior epigastric artery perforator flap. In Proceedings of SPIE - The International Society for Optical Engineering. Vol. 8618. 2013. 861806 https://doi.org/10.1117/12.2004972
Saint-Cyr, Michel ; Lakhiani, Chrisovalantis ; Cheng, Angela ; Mangum, Michael ; Liang, Jinyang ; Teotia, Sumeet ; Livingston, Edward H. ; Zuzak, Karel J. / In-vivo quantitative evaluation of perfusion zones and perfusion gradient in the deep inferior epigastric artery perforator flap. Proceedings of SPIE - The International Society for Optical Engineering. Vol. 8618 2013.
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abstract = "The selection of well-vascularized tissue during DIEP flap harvest remains controversial. While several studies have elucidated cross-midline perfusion, further characterization of perfusion to the ipsilateral hemiabdomen is necessary for minimizing rates of fat necrosis or partial fat necrosis in bilateral DIEP flaps. Eighteen patients (29 flaps) underwent DIEP flap harvest using a prospectively designed protocol. Perforators were marked and imaged with a novel system for quantitatively measuring tissue oxygenation, the Digital Light Hyperspectral Imager. Images were then analyzed to determine if perforator selection influenced ipsilateral flap perfusion. Flaps based on a single lateral row perforator (SLRP) were found to have a higher level of hemoglobin oxygenation in Zone I (mean {\%}HbO2 = 76.1) compared to single medial row perforator (SMRP) flaps ({\%}HbO2 = 71.6). Perfusion of Zone III relative to Zone I was similar between SLRP and SMRP flaps (97.4{\%} vs. 97.9{\%}, respectively). These differences were not statistically significant (p>0.05). Perfusion to the lateral edge of the flap was slightly greater for SLRP flaps compared SMRP flaps (92.1{\%} vs. 89.5{\%}, respectively). SMRP flaps had superior perfusion travelling inferiorly compared to SLRP flaps (88.8{\%} vs. 83.9{\%}, respectively). Overall, it was observed that flaps were better perfused in the lateral direction than inferiorly. Significant differences in perfusion gradients directed inferiorly or laterally were observed, and perforator selection influenced perfusion in the most distal or inferior aspects of the flap. This suggests broader clinical implications for flap design that merit further investigation.",
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