Medizinische Universität Graz - Research portal
Selected Publication:
Gatterer, S.
Preoperative Detection of Deep Inferior Epigastric Perforators - A Local Assessment by Various Appliances
Humanmedizin; [ Diplomarbeit ] Medizinische Universität Graz; 2021. pp. 62
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- Authors Med Uni Graz:
- Advisor:
- Kamolz Lars-Peter
- Luze Hanna
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- Abstract:
- Introduction: Breast cancer is the commonest malignancy in the world and is the most frequent type of cancer in women. On average, one in eight women will develop breast cancer during their lifetime. The only curative therapy is surgical resection of the degenerated tissue, often supplemented with radiation or chemotherapy. In about 40% of breast cancer patients, breast conserving therapy is not possible, leading to subcutaneous mastectomy as the only remaining option. Especially for those patients, the psychological and physical stress triggered by the disease and therapy is often enormous, and even after successful treatment, the absence of the breast can have negative psychosocial effects. Breast reconstruction is therefore a way to help sufferers regain greater self-confidence, well-being, and female identification. Breast reconstruction techniques are diverse and range from the use of implants to the transplantation of autologous tissue. In the latter, the deep inferior epigastric perforator (DIEP) flap is the current gold standard and is used by many surgeons worldwide with excellent results. In this procedure, excess skin and subcutaneous adipose tissue is transplanted from the abdomen to the breast to provide a natural and aesthetic projection. A key role is played by the so-called perforator vessels, which branch off from larger, deeper vessels to supply the flap tissue. To ensure an optimal result in the reconstruction, it is essential for the surgeon to know the patient's individual vascular anatomy and thus plan the operation in the most viable way. CT angiography is the current gold standard for preoperative perforator detection. However, this method is expensive, time-consuming and cannot be performed in many cases because it requires a contrast medium, which can cause allergic reactions and renal failure. In this work, three non-invasive imaging techniques that are harmless to the human body were tested to search for alternatives to CT angiography. The techniques involved a thermal camera, a hyperspectral camera, and a laser Doppler system. Methods: This pilot project was performed in 18 subjects at the Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria. After cooling the abdomen for 20 minutes, the three technologies were tested for their ability to detect perforators. The results were compared and matched with reference perforators obtained by using a pencil Doppler. The results were then statistically analyzed. Results: Thermal imaging achieved the highest detection rate with a sensitivity of 92.59%, followed by the hyperspectral camera with 25.93%. The laser Doppler system was unable to detect a single perforator and therefore achieved 0% sensitivity. Regardless of the technology used, there were no correlations of detection rates with age, sex, BMI, or abdominal circumference. Discussion/Conclusion: Of the devices used, only the thermal imaging camera achieved a satisfactory detection rate. As this device was also effective in terms of practicality and handiness and can be used independently of individual health data, this technology is a viable additional technology to conventional techniques. Thermal imaging may particularly be used as a valuable alternative in patients where CT angiography is not possible. However, follow-up studies with larger patient cohorts are needed to evaluate the full potential of thermal imaging for perforator detection.