scholarly journals Dynamic infrared thermography (DIRT) in Deep Inferior Epigastric Perforator (DIEP) flap breast reconstruction: standardization of the measurement set-up

Gland Surgery ◽  
2019 ◽  
Vol 8 (6) ◽  
pp. 799-805 ◽  
Author(s):  
Filip E. F. Thiessen ◽  
Thierry Tondu ◽  
Nicolas Vermeersch ◽  
Ben Cloostermans ◽  
Ralv Lundahl ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Infrared Thermography ◽  
Diep Flap ◽  
Deep Inferior Epigastric Perforator ◽  
Set Up

Observations from Implementation of the ERAS Protocol after DIEP Flap Breast Reconstruction

2021 ◽  
Author(s):  
Nicholas T. Haddock ◽  
Ricardo Garza ◽  
Carolyn E. Boyle ◽  
Sumeet S. Teotia
Keyword(s):  
Breast Reconstruction ◽  
Patient Outcomes ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Compliance Rate ◽  
Fluid Management ◽  
Control Group ◽  
Diep Flap ◽  
Deep Inferior Epigastric Perforator ◽  
Eras Protocol

Abstract Background The Enhanced Recovery After Surgery (ERAS) protocol is a multivariate intervention requiring the help of several departments, including anesthesia, nursing, and surgery. This study seeks to observe ERAS compliance rates and obstacles for its implementation at a single academic institution. Methods This is a retrospective study looking at patients who underwent deep inferior epigastric perforator (DIEP) flap breast reconstruction from January 2016 to September 2019. The ERAS protocol was implemented on select patients early 2017, with patients from 2016 acting as a control. Thirteen points from the protocol were identified and gathered from the patient's electronic medical record (EMR) to evaluate compliance. Results Two hundred and six patients were eligible for the study, with 67 on the control group. An average of 6.97 components were met in the pre-ERAS group. This number rose to 8.33 by the end of 2017. Compliance peaked with 10.53 components met at the beginning of 2019. The interventions most responsible for this increase were administration of preoperative medications, goal-oriented intraoperative fluid management, and administration of scheduled gabapentin postoperatively. The least met criterion was intraoperative ketamine goal of >0.2 mg/kg/h, with a maximum compliance rate of 8.69% of the time. Conclusion The introduction of new protocols can take over a year for full implementation. This is especially true for protocols as complex as an ERAS pathway. Even after years of consistent use, compliance gaps remain. Staff-, patient-, or resource-related issues are responsible for these discrepancies. It is important to identify these issues to address them and optimize patient outcomes.

scholarly journals Refractory Donor-Site Seroma Following DIEP Breast Reconstruction

2020 ◽  
Vol 6 ◽  
pp. 2513826X1989883
Author(s):  
Trina V. Stephens ◽  
Nancy Van Laeken ◽  
Sheina A. Macadam
Keyword(s):  
Literature Review ◽  
Breast Reconstruction ◽  
Donor Site ◽  
Diep Flap ◽  
First Line ◽  
Percutaneous Aspiration ◽  
Autologous Breast Reconstruction ◽  
History Of ◽  
Deep Inferior Epigastric Perforator ◽  
Latissimus Dorsi Flaps

Donor-site seroma formation is a complication of autologous breast reconstruction reported most commonly with the use of latissimus dorsi flaps. First-line treatment is percutaneous aspiration which leads to resolution in the majority of cases. Those that persist may progress to a chronic, refractory seroma, which can prove challenging in terms of treatment. The aim of this article is to provide an updated literature review of interventions for chronic donor-site seroma and present the case of a 65-year-old female with a recalcitrant abdominal seroma following deep inferior epigastric perforator (DIEP) flap breast reconstruction. Literature review revealed a single article that reported 2 cases of persistent donor-site seroma after DIEP flap breast reconstruction. The patient presented here underwent repeat aspiration, drain placement, and multiple surgical procedures to achieve resolution. In total, the post-reconstruction seroma history of the patient extended over approximately 14 months. We conclude with evidence-based suggestions for chronic, donor-site seroma prevention and treatment.

scholarly journals Infrared Thermography for DIEP Flap Breast Reconstruction Part II: Analysis of the Results

Proceedings ◽  
2019 ◽  
Vol 27 (1) ◽  
pp. 49 ◽  
Author(s):  
Gunther Steenackers ◽  
Ben Cloostermans ◽  
Filip Thiessen ◽  
Yarince Dirkx ◽  
Jan Verstockt ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Infrared Thermography ◽  
Hot Spots ◽  
Breast Surgery ◽  
Infrared Camera ◽  
Diep Flap ◽  
Flap Surgery ◽  
Qualitative Information ◽  
Thermal Measurements ◽  
The Individual

Dynamic infrared thermography (DIRT) has been used to locate perforating vessels and to assist in reconstructive breast surgery. Qualitative information on the perforating vessels is obtained by analysing the rate and pattern of rewarming of hot spots which are easily registered with an infrared camera. Thermal measurements are made before and during surgery and are compared with the CT-images available before operation. The thermal images can provide the individual influence of each perforator on the flap, as well as the dimensions of the perfused area. We will investigate if the influence of the different dominant perforators can be assessed by dynamic infrared thermography as a useful tool for recostructive DIEP-flap surgery.

Alternative flaps for microsurgical breast reconstruction

2021 ◽  
pp. 1107-1114
Author(s):  
Hinne A. Rakhorst
Keyword(s):  
Breast Reconstruction ◽  
Standard Care ◽  
Donor Site ◽  
Perforator Flap ◽  
Donor Site Morbidity ◽  
The Body ◽  
Diep Flap ◽  
Deep Inferior Epigastric Perforator ◽  
Muscle Sparing ◽  
Breast Reconstructive Surgery

Microsurgery in general has made dramatic improvements over the past decades. This applies to microsurgery in general and to breast reconstructive surgery especially. The demand for autologous breast reconstruction has risen. Since the introduction of the free transverse rectus abdominis myocutaneous (TRAM) flaps, through the muscle-sparing TRAM, flaps designs have evolved into the current gold standard, the deep inferior epigastric perforator (DIEP) flap. From experiences and increasing numbers of flap procedures performed by surgeons, techniques became more familiar and part of standard care. These factors gave rise to the development of a growing number of areas of the body where tissues of interest can be harvested using perforator flap-based techniques. This chapter discusses the most common as well as the ‘rising stars’ in terms of flaps to be used as alternative flaps to the DIEP flap for breast reconstruction. It discusses practical issues on dissection as well as donor site morbidity.

scholarly journals Objective photographic assessments and comparisons of immediate bilateral breast reconstruction using deep inferior epigastric perforator flaps and implants

2021 ◽  
Vol 48 (5) ◽  
pp. 473-482
Author(s):  
Hyun Ho Han ◽  
Jin Mi Choi ◽  
Jin Sup Eom
Keyword(s):  
Breast Reconstruction ◽  
Operation Time ◽  
Bilateral Mastectomy ◽  
Average Weight ◽  
Diep Flap ◽  
Flap Reconstruction ◽  
Immediate Reconstruction ◽  
Hospitalization Period ◽  
Deep Inferior Epigastric Perforator ◽  
Bilateral Reconstruction

Background The increasing number of bilateral breast cancer patients has been accompanied by a growing need for bilateral mastectomy with immediate reconstruction. However, little research has investigated the complications and aesthetic outcomes related to bilateral reconstruction. Therefore, we analyzed retrospective data comparing the outcomes of bilateral reconstruction using deep inferior epigastric perforator (DIEP) flaps or implants.Methods This study included 52 patients (24 DIEP group and 28 implant group) who underwent bilateral mastectomy with immediate reconstruction between 2010 and 2020. Patient demographics, surgical characteristics, and complications were recorded. The difference between the left and right position of the nipple-areolar complex with respect to the sternal notch point at the clavicle was measured, and breast symmetry was evaluated.Results The average weight of breasts reconstructed with DIEP flaps (417.43±152.50 g) was higher than that of breasts with implants. The hospitalization period and operation time were significantly longer in the DIEP group. Early complications were significantly more common in the implant group (36.53%) than in the DIEP group. The angles between the nipples and the horizontal line were 1.09°±0.71° and 1.75°±1.45° in the DIEP and implant groups, respectively.Conclusions Although the surgical burden is lower, breast reconstruction using implants requires greater attention with respect to implant positioning, asymmetry, and complications than DIEP flap reconstruction. DIEP flap reconstruction has a prolonged operation time and a high risk of flap failure, but yields excellent cosmetic results and does not require intensive follow-up. Patients should be consulted to determine the most suitable option for them.

scholarly journals Dynamic infrared thermography for DIEP flap breast reconstruction: initial processing results

2020 ◽  
Author(s):  
G. Steenackers ◽  
J. Verstockt ◽  
B. Ribbens ◽  
F. Thiessen ◽  
W. Tjalma
Keyword(s):  
Breast Reconstruction ◽  
Infrared Thermography ◽  
Diep Flap ◽  
Initial Processing
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