Perioperative Diffuse Optical Imaging of Tissue Blood Flow and Oxygenation for Optimization of Mastectomy Skin Flap Viability

Postoperative mastectomy skin flap necrosis (MSFN) occurs in up to 30% of cases after conventional implant-based breast reconstruction, with reported complication rates exceeding 50%1-8. The violation of the skin envelope can lead to infection, implant exposure, and implant loss. A technology that allows the surgeon to assess and optimize preservation of the mastectomy skin flap while avoiding MSFN is essential to ensure successful surgical outcomes. Traditional approaches for assessing skin flap viability rely largely on the surgeon’s assessment of skin flap color, capillary refill, temperature, turgor, and dermal bleeding9, 10, which have been shown to be unreliable due to the lack of objectivity4. MSFN ensues when blood/oxygen supply to the skin flap is insufficient to meet metabolic needs. Perioperative assessment of ischemic-hypoxic regions/volumes in skin flaps may provide objective guidance for preoperative planning, intraoperative excision, and postoperative management to prevent MSFN. A number of techniques have been explored to detect skin flaps at risk of necrosis, including laser Doppler flowmetry (LDF)11-14 and laser speckle contrast imaging (LSCI) for blood flow measurements in superficial tissues (