The Role of Intraoperative Laser Speckle Imaging in Reducing Postoperative Complications in Breast Reconstruction
Year: 2019
Type: letter
Abstract: Sir: We read with interest the article by To and colleagues entitled “Intraoperative Tissue Perfusion Measurement by Laser Speckle Imaging: A Potential Aid for Reducing Postoperative Complications in Free Flap Breast Reconstruction.”1 The current standard for assessing skin flap viability is clinical judgment. Invasive technologies such as laser-assisted indocyanine green angiography have been used; however, they are associated with high costs, possible anaphylaxis, and noncontinuous imaging.2Laser speckle contrast imaging has emerged over the past decade as a method of real-time imaging of perfusion dynamics based on moving red blood cells, which cause scattering of coherent laser light. Spatial and temporal fluctuations in laser speckle patterning allow for two-dimensional mapping of tissue perfusion. However, a significant limitation of laser speckle contrast imaging is the shallow penetration depth (approximately 1 mm). Our laboratory has recently introduced a novel speckle contrast diffuse correlation tomography device that overcomes the depth limitation of laser speckle contrast imaging. Speckle contrast diffuse correlation tomography uses a galvanometer mirror to remotely deliver focused near-infrared point light to source positions and uses a sensitive scientific complementary metal oxide semiconductor camera to rapidly quantify diffuse spatial speckle fluctuations. Because point illumination produces high photon density for deep tissue penetration, speckle contrast diffuse correlation tomography enables noncontact three-dimensional imaging of blood flow distributions in relatively deep tissues (approximately 10 mm). This system also integrates an innovative photometric stereo technique with the same camera to obtain tissue surface geometry. Speckle contrast diffuse correlation tomography has been tested in tissue-simulating phantoms, rodent brains, human burns, wounds, and mastectomy skin flaps. In a preliminary study using speckle contrast diffuse correlation tomography and commercially available indocyanine green angiography, we observed similar perfusion patterns on mastectomy skin flap surfaces. Interestingly, lateral and depth heterogeneities in blood flow distribution were captured by our speckle contrast diffuse correlation tomography, suggesting the value of imaging the entire mastectomy skin flap volume. In addition, we also obtain three-dimensional maps of tissue blood flow distributions. Compared to two-dimensional mapping, three-dimensional imaging quantifies blood flow distributions more accurately. We are currently testing speckle contrast diffuse correlation tomography in patients with the expectation that perioperative monitoring of ischemic tissues and their recoveries in mastectomy skin flaps will provide objective information for the assessment and management of skin flap viability to prevent skin flap necrosis and other complications. Because postoperative mastectomy skin flap thickness is approximately 10 mm, imaging techniques with depth capabilities and three-dimensional analysis may be more beneficial than laser speckle contrast imaging.3–5 In conjunction with the findings of To et al., these studies collectively suggest that noninvasive detection of light scattering is a promising technology that may be used to identify tissue with regional ischemia for varying reconstructive approaches. To et al. are to be commended for their use of laser speckle contrast imaging to assess the intraoperative feasibility of this technology. Future work should determine the role of intraoperative noninvasive, noncontact methodologies to accurately predict tissue viability in both prosthetic and autologous breast reconstruction. Identification of compromised tissue intraoperatively may augment surgical decision-making and allow for revisions before leaving the operating room. ACKNOWLEDGMENTS Lesley Wong, M.D., and Guoqiang Yu, Ph.D., are current recipients of a National Endowment for Plastic Surgery grant (3048112770) from the Plastic Surgery Foundation for noninvasive mastectomy flap monitoring in breast reconstruction. Ryan C. DeCoster, M.D., is supported by a National Cancer Institute training grant (T32CA160003). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Plastic Surgery Foundation. DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication. Alisha Bonaroti, M.D., M.S.Division of Plastic Surgery Ryan C. DeCoster, M.D.Division of Plastic Surgery andLucille P. Markey Cancer Center Siavash Mazdeyasna, M.S.Chong Huang, Ph.D.Guoqiang Yu, Ph.D.F. Joseph Halcomb III, M.D.Department of Biomedical Engineering Lesley Wong, M.D.Lucille P. Markey Cancer CenterUniversity of KentuckyLexington, Ky.
Source: Plastic & Reconstructive Surgery
Authors: Alisha Bonaroti, Ryan C. DeCoster, Siavash Mazdeyasna, Chong Huang, Guoqiang Yu, Lesley Wong
Language: English
Subfield: Radiology, Nuclear Medicine and Imaging
Field: Medicine
Domain: Health Sciences
Open Access status: green
Awards: Continuous and Longitudinal Monitoring of Cerebral Blood Flow and Metabolism in Freely Moving Rodents, Development of a Wearable Fluorescence Imaging Device for Intraoperative Identification of Brain Tumors, Perioperative Diffuse Optical Imaging of Tissue Blood Flow and Oxygenation for Optimization of Mastectomy Skin Flap Viability, High-density optical tomography of cerebral blood flow and metabolism in small animals, Noninvasive Noncontact High-Density Optical Imaging of Neonatal Intraventricular Hemorrhage, A Low-cost Compact Diffuse Speckle Contrast Flow-oximeter for Neonatal Brain Monitoring, Time-resolved laser speckle contrast imaging of resting-state functional connectivity in neonatal brain, Development of a Wearable Fluorescence Imaging Device for IntraoperativeIdentification of Brain Tumors, Oncology Research Training for Surgeon-Scientists
OpenAlex ID: W2968494079