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Perioperatives Management der Autologen Brustrekonstruktion in Koop. mit der DAM Ort: Raum 14, 1. OG | |
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Contrast-Free Perfusion Assessment in DIEP Flap Breast Reconstruction: Hyperspectral Imaging Compared With Indocyanine Green Angiography 1: Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, Klinikum Kassel, Teaching Hospital of Philipps University Marburg, Kassel, Germany; 2: Innovation Center Computer Assisted Surgery (ICCAS), Leipzig University, Leipzig, Germany; 3: Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim at Heidelberg University, Germany; 4: Dept. of Plastic and Aesthetic Surgery, Sana Krankenhaus Gerresheim, Gräulinger Straße 120, Düsseldorf, Germany.; 5: Department of Plastic and Hand Surgery, Klinikum Rechts der Isar, Technical University Munich, 81675 Munich, Germany; 6: Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany; 7: Department of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University, Munich, Germany; 8: Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Klinik Ludwigshafen, Heidelberg University, Ludwigshafen, Germany Accurate intraoperative perfusion assessment is essential in deep inferior epigastric perforator (DIEP) flap breast reconstruction, where indocyanine green fluorescence angiography (ICG-FA) is widely used but limited by its need for intravenous dye, restricted repeatability, and subjective interpretation. Hyperspectral imaging (HSI) provides contrast-free, quantitative perfusion metrics, and in this prospective study of 27 patients (33 intraoperative analyses), we evaluated whether HSI reflects perfusion differences identified by ICG-FA. Standardized HSI data were co-registered to surgeon-defined ICG+ and ICG− regions, allowing pixel-level comparison of tissue oxygenation, near-infrared perfusion, tissue hemoglobin index, and tissue water index. Intraindividual analyses consistently differentiated ICG+ from ICG− regions, with significant median Δ values across all parameters (p < 0.001) and moderate to very large effect sizes, while PCA and UMAP demonstrated clear spectral separability. No clinical or intraoperative variable remained associated with ΔHSI parameters after adjustment, and complications were rare, with one case of fat necrosis (3.7%). These findings show that HSI reliably reproduces ICG-FA perfusion patterns in DIEP flaps, supporting its use as a contrast-free modality for intraoperative perfusion assessment. To facilitate interpretation, we developed a DIEP-specific visualization metric (DIEP Stasis Index) that highlights pixel-wise THI differences. Controlled trials are warranted to define the clinical impact of HSI-guided decision-making. | |