DIEP flap breast reconstructions: thermographic assistance as a possibility for perforator mapping and improvement of DIEP flap quality

In the modern world, one-third or more of breast cancer patients still undergo uni- or bilateral mastectomy. Breast cancer patients, in general, have a good prognosis and long-term survival. Therefore, the treatment must not only focus on survival but also on the quality of life. Breast reconstruction with an autologous free deep inferior epigastric artery perforator (DIEP) flap is one of the preferred options after mastectomy. A challenging step in this procedure is the selection of a suitable perforator that provides sufficient blood supply for the flap to prevent necrosis after anastomosis. In this pilot study, the possibilities for dynamic infrared thermography (DIRT) are investigated to select the best suitable perforator. The measurements are done with external cooling in the preoperative stage to accurately predict the location of the dominant perforators. During the surgery, in the peroperative stage, measurements are done for mapping the influence of a specific perforator on the perfused areas of the abdominal flap. Perforators are sequentially closed and opened again to map the influence of that perforator on the vascularization of the flap, visualized with the help of the thermographic camera. The acquired steady-state thermal images could help decide which parts of the abdominal flap to use for the reconstruction so that the chance of (partial) necrosis is reduced. In the postoperative stage, DIRT could visualize the arterial and or venous thrombosis before they become clinically obvious as (partial) necrosis. At present DIRT seems to be a valuable investigation for the pre-, per-, and postoperative phases of DIEP-flap reconstructions. Large, high-quality clinical studies are needed to determine its definitive role.