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Molitor M, Mestak O, Pink R, Foltan R, Sukop A, Lucchina S. The use of sentinel skin islands for monitoring buried and semi-buried micro-vascular flaps. Part I: Summary and brief description of monitoring methods. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2021; 165:113-130. [PMID: 33821844 DOI: 10.5507/bp.2021.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 02/26/2021] [Indexed: 11/23/2022] Open
Abstract
Micro-vascular flaps have been used for the repair of challenging defects for over 45 years. The risk of failure is reported to be around 5-10% which despite medical and technical advances in recent years remains essentially unchanged. Precise, continuous, sensitive and specific monitoring together with prompt notification of vascular compromise is crucial for the success of the procedure. In this review, we provide a classification and brief description of the reported methods for monitoring the micro-vascular flap and a summary of the benefits over direct visual monitoring. Over 40 different monitoring techniques have been reported but their comparative merits are not always obvious. One looks for early detection of a flap's compromise, improved flap salvage rate and a minimal false-positive or false-negative rate. The cost-effectiveness of any method should also be considered. Direct visualisation of the flap is the method most generally used and still seems to be the simplest, cheapest and most reliable method for flap monitoring. Considering the alternatives, only implantable Doppler ultrasound probes, near infrared spectroscopy and laser Doppler flowmetry have shown any evidence of improved flap salvage rates over direct visual monitoring.
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Affiliation(s)
- Martin Molitor
- Department of Plastic Surgery, First Faculty of Medicine Charles University and Na Bulovce Hospital, Prague, Czech Republic
| | - Ondrej Mestak
- Department of Plastic Surgery, First Faculty of Medicine Charles University and Na Bulovce Hospital, Prague, Czech Republic
| | - Richard Pink
- Department of Maxillofacial Surgery, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Rene Foltan
- Department of Maxillofacial Surgery, General University Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Andrej Sukop
- Department of Plastic Surgery, University Hospital Kralovske Vinohrady and 3rd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Stefano Lucchina
- Hand Unit, General Surgery Department, Locarno's Regional Hospital, Via Ospedale 1, 6600 Locarno, Switzerland
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Garg G, Benchekroun MT, Abraham T. FDG-PET/CT in the Postoperative Period: Utility, Expected Findings, Complications, and Pitfalls. Semin Nucl Med 2017; 47:579-594. [PMID: 28969758 DOI: 10.1053/j.semnuclmed.2017.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
FDG-PET/CT as a modality is increasingly used for detection of recurrence and for restaging in patients with clinical suspicion of malignancy, as well as in patients with elevated tumor markers. However, there are many pitfalls in the interpretation of these scans when the studies are performed after some treatment. Some of these are attributed to normal physiological distribution and are compounded when there are inflammatory changes occurring after surgery. The body's inherent response to the surgical insult results in this inflammation. In addition, there are also complications that can happen following surgery, causing increased FDG uptake. Despite various fallacies, FDG-PET/CT provides valuable information in evaluation of residual and recurrent malignant disease. In this article, we aim to describe some of these postsurgical changes secondary to inflammation, common surgical complications, and finally, the utility of FDG-PET/CT in these patients to detect recurrent disease, even in the background of postsurgical changes.
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Affiliation(s)
- Gunjan Garg
- Division of Nuclear Medicine, Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Mohammed Taoudi Benchekroun
- Division of Nuclear Medicine, Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Tony Abraham
- Division of Nuclear Medicine, Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY.
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Ko GB, Kim KY, Yoon HS, Lee MS, Son JW, Im HJ, Lee JS. Evaluation of a silicon photomultiplier PET insert for simultaneous PET and MR imaging. Med Phys 2016; 43:72. [PMID: 26745901 DOI: 10.1118/1.4937784] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE In this study, the authors present a silicon photomultiplier (SiPM)-based positron emission tomography (PET) insert dedicated to small animal imaging with high system performance and robustness to temperature change. METHODS The insert consists of 64 LYSO-SiPM detector blocks arranged in 4 rings of 16 detector blocks to yield a ring diameter of 64 mm and axial field of view of 55 mm. Each detector block consists of a 9 × 9 array of LYSO crystals (1.2 × 1.2 × 10 mm(3)) and a monolithic 4 × 4 SiPM array. The temperature of each monolithic SiPM is monitored, and the proper bias voltage is applied according to the temperature reading in real time to maintain uniform performance. The performance of this PET insert was characterized using National Electrical Manufacturers Association NU 4-2008 standards, and its feasibility was evaluated through in vivo mouse imaging studies. RESULTS The PET insert had a peak sensitivity of 3.4% and volumetric spatial resolutions of 1.92 (filtered back projection) and 0.53 (ordered subset expectation maximization) mm(3) at center. The peak noise equivalent count rate and scatter fraction were 42.4 kcps at 15.08 MBq and 16.5%, respectively. By applying the real-time bias voltage adjustment, an energy resolution of 14.2% ± 0.3% was maintained and the count rate varied ≤1.2%, despite severe temperature changes (10-30 °C). The mouse imaging studies demonstrate that this PET insert can produce high-quality images useful for imaging studies on the small animals. CONCLUSIONS The developed MR-compatible PET insert is designed for insertion into a narrow-bore magnetic resonance imaging scanner, and it provides excellent imaging performance for PET/MR preclinical studies.
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Affiliation(s)
- Guen Bae Ko
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul 110-799, South Korea and Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul 110-799, South Korea
| | - Kyeong Yun Kim
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul 110-799, South Korea and Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul 110-799, South Korea
| | - Hyun Suk Yoon
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul 110-799, South Korea and Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul 110-799, South Korea
| | - Min Sun Lee
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul 110-799, South Korea and Interdisciplinary Program in Radiation Applied Life Science, Seoul National University College of Medicine, Seoul 110-799, South Korea
| | - Jeong-Whan Son
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul 110-799, South Korea and Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul 110-799, South Korea
| | - Hyung-Jun Im
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul 110-799, South Korea
| | - Jae Sung Lee
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul 110-799, South Korea; Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul 110-799, South Korea; Interdisciplinary Program in Radiation Applied Life Science, Seoul National University College of Medicine, Seoul 110-799, South Korea; and Institute of Radiation Medicine, Medical Research Center, Seoul National University College of Medicine, Seoul 110-799, South Korea
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