A Reliable Method for the Monitoring of Buried Free Flaps Using Near-Infrared Spectroscopy

Background In recent years, there has been a shift toward nipple-sparing mastectomy (NSM) techniques which often negates the need for reconstruction with exposed cutaneous donor flap tissues. Although techniques for the monitoring of buried flaps have been proposed, none have been able to provide the benefits that come with cutaneous monitoring via near-infrared spectroscopy (NIRS). Therefore, we herein propose a novel method for monitoring deepithelialized flap tissues deep to the mastectomy flaps using NIRS technology.

Methods An NSM with free flap reconstruction was performed. The flap was designed with a skin island for placement of a cutaneous NIRS probe. Next, a silicone NIRS probe was placed on a deepithelialized portion of the flap under the mastectomy flap. The readings from this tunneled device were then compared to the control measurements obtained from the cutaneous NIRS monitor. This procedure was performed on three consecutive patients. The changes in StO2 recorded from both devices were compared using a paired, two-tailed Student's t-test.

Results During flap monitoring, there were no issues with probe dislodgement and signal quality averaged greater than 90. Furthermore, probe removal was easily accomplished at bedside. There was no harm to the mastectomy skin flaps by affixing the probe and the pocket which contained the probe quickly closed down after removal. Using the Student's t-test, a p-value of 0.995 was calculated indicating no statistically significant difference between the StO2 readings from the cutaneous and the tunneled probes.

Conclusion By using this novel method, NIRS technology can reliably be applied to the monitoring of buried free flap tissues. The proposed technique could be applied to a variety of flaps beyond the realm of breast reconstruction and may prove to be particularly useful in the setting of head and neck reconstruction. The results of this study suggest that high quality postoperative flap monitoring is possible without compromising the aesthetic result.

National Patterns of Breast Reconstruction and Nipple-Sparing Mastectomy for Breast Cancer, 2005-2015

BACKGROUND

The purpose of this study was to explore national patterns in the uptake of breast reconstruction and nipple-sparing mastectomy (NSM).

METHODS

We used the National Cancer Database to identify all women who underwent mastectomy for stage 0-III breast cancer between 2005-2015. Multivariable logistic regression was used to determine factors associated with receipt of reconstruction, with subset analyses performed to determine trends and predictors of NSM in those who underwent mastectomy with reconstruction.

RESULTS

Our cohort consisted of 395,815 women, 238,568 (60.3%) who underwent mastectomy alone and 157,247 (39.7%) who underwent mastectomy followed by reconstruction. The use of breast reconstruction increased from 22.3% of mastectomy cases in 2005 to 49.7% of mastectomy cases in 2015 (odds ratio [OR] 9.7, 95% confidence interval [CI] 7.3-12.8). Among those receiving reconstruction, the use of NSM increased from 1.7% in 2005 to 14.3% in 2015 (OR 9.4, 95% CI 7.1-12.5), with increased utilization among those with early-stage and locally advanced disease, such that by 2015, NSM was performed in 15.3% of mastectomies with reconstruction for DCIS, 14.3% of mastectomies with reconstruction for stage I-II breast cancer, and 10.7% of mastectomies with reconstruction for stage III breast cancer. Factors strongly predicting receipt of NSM included age < 45 years, smaller clinical tumor size, clinically node negative disease, use of neoadjuvant therapy, and facility type.

CONCLUSIONS

There has been a dramatic increase in the use of breast reconstruction and NSM between 2005-2015. Further prospective studies evaluating oncologic outcomes of NSM in locally advanced breast cancer are warranted.