Laser Speckle Contrast Imaging: Introducing a New Method for Real-Time Microcirculation Imaging in Plastic Surgery
Stephen M. Lu, MD, MDiv, Wojciech Dec, MD, Oren Z. Lerman, MD.
Northwell Health/Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA.
Laser speckle contrast imaging (LSCI), a technology which allows touch-free, real-time, non-invasive visualization and monitoring of microcirculation, has been implemented in animal models, neurosurgery, vascular, burn, oral, pediatric, and general surgery, but not yet in plastic surgery. In this pilot study, we introduce several applications of visualizing perfusion (and changes therein) for hand, breast, head and neck, and general reconstructive surgery. Methods: The LSCI device was used to verify an Allen's test; to image changes in blood flow to fingers with and without a tourniquet; to assess breast skin after mastectomy but prior to reconstruction; to visualize perfusion of a DIEP flap after elevation on its perforators; and to help identify perforators of an ALT flap. Results: LSCI quantitatively showed changes in blood flow to the hand and to a finger with tourniquet applied as well as hyperemia upon release. It also showed areas of decreased perfusion after mastectomy, though a threshold for clinical survival has yet to be determined. Imaging of a DIEP flap confirmed areas of increased and decreased perfusion in relation to the perforators. And LSCI correctly identified relevant perforators prior to ALT harvest as well as changes in flow when feeding vessels were clamped. Conclusion: LSCI is effective across diverse surgical procedures for quickly and accurately visualizing and assessing blood flow and therefore tissue perfusion. As it does not require patient contact, dyes/injections, or disposables, LSCI could become a widely applicable, cost-effective, and powerful tool for plastic surgeons.
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