Free Flap Monitoring Using Near-Infrared Spectroscopy

2016 ◽  
Vol 76 (5) ◽  
pp. 590-597 ◽  
Author(s):  
Ying Chen ◽  
Zhenzhou Shen ◽  
Zhimin Shao ◽  
Peirong Yu ◽  
Jiong Wu
Keyword(s):  
Infrared Spectroscopy ◽  
Near Infrared Spectroscopy ◽  
Free Flap ◽  
Near Infrared ◽  
Free Flap Monitoring ◽  
Flap Monitoring

scholarly journals Near-Infrared Spectroscopy (NIRS) versus Hyperspectral Imaging (HSI) to Detect Flap Failure in Reconstructive Surgery: A Systematic Review

Life ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. 65
Author(s):  
Anouk A. M. A. Lindelauf ◽  
Alexander G. Saelmans ◽  
Sander M. J. van Kuijk ◽  
René R. W. J. van der Hulst ◽  
Rutger M. Schols
Keyword(s):  
Systematic Review ◽  
Infrared Spectroscopy ◽  
Hyperspectral Imaging ◽  
Near Infrared Spectroscopy ◽  
Free Flap ◽  
Near Infrared ◽  
Flap Survival ◽  
Non Invasive ◽  
Vascular Compromise ◽  
Flap Monitoring

Rapid identification of possible vascular compromise in free flap reconstruction to minimize time to reoperation improves achieving free flap salvage. Subjective clinical assessment, often complemented with handheld Doppler, is the golden standard for flap monitoring; but this lacks consistency and may be variable. Non-invasive optical methods such as near-infrared spectroscopy (NIRS) and hyperspectral imaging (HSI) could facilitate objective flap monitoring. A systematic review was conducted to compare NIRS with HSI in detecting vascular compromise in reconstructive flap surgery as compared to standard monitoring. A literature search was performed using PubMed and Embase scientific database in August 2021. Studies were selected by two independent reviewers. Sixteen NIRS and five HSI studies were included. In total, 3662 flap procedures were carried out in 1970 patients using NIRS. Simultaneously; 90 flaps were performed in 90 patients using HSI. HSI and NIRS flap survival were 92.5% (95% CI: 83.3–96.8) and 99.2% (95% CI: 97.8–99.7). Statistically significant differences were observed in flap survival (p = 0.02); flaps returned to OR (p = 0.04); salvage rate (p < 0.01) and partial flap loss rate (p < 0.01). However, no statistically significant difference was observed concerning flaps with vascular crisis (p = 0.39). NIRS and HSI have proven to be reliable; accurate and user-friendly monitoring methods. However, based on the currently available literature, no firm conclusions can be drawn concerning non-invasive monitoring technique superiority

scholarly journals A Wireless Near-Infrared Spectroscopy Device for Flap Monitoring: Proof of Concept in a Porcine Musculocutaneous Flap Model

2021 ◽  
Author(s):  
Changsheng Wu ◽  
Alina Y. Rwei ◽  
Jong Yoon Lee ◽  
Wei Ouyang ◽  
Lauren Jacobson ◽  
...  
Keyword(s):  
Infrared Spectroscopy ◽  
User Experience ◽  
Near Infrared Spectroscopy ◽  
Near Infrared ◽  
Tissue Oxygen Saturation ◽  
False Alarms ◽  
Battery Life ◽  
Novel Device ◽  
Free Flap Monitoring ◽  
Flap Monitoring

Abstract Background Current near-infrared spectroscopy (NIRS)-based systems for continuous flap monitoring are highly sensitive for detecting malperfusion. However, the clinical utility and user experience are limited by the wired connection between the sensor and bedside console. This wire leads to instability of the flap–sensor interface and may cause false alarms. Methods We present a novel wearable wireless NIRS sensor for continuous fasciocutaneous free flap monitoring. This waterproof silicone-encapsulated Bluetooth-enabled device contains two light-emitting diodes and two photodetectors in addition to a battery sufficient for 5 days of uninterrupted function. This novel device was compared with a ViOptix T.Ox monitor in a porcine rectus abdominus myocutaneous flap model of arterial and venous occlusions. Results Devices were tested in four flaps using three animals. Both devices produced very similar tissue oxygen saturation (StO2) tracings throughout the vascular clamping events, with obvious and parallel changes occurring on arterial clamping, arterial release, venous clamping, and venous release. Small interdevice variations in absolute StO2 value readings and magnitude of change were observed. The normalized cross-correlation at zero lag describing correspondence between the novel NIRS and T.Ox devices was >0.99 in each trial. Conclusion The wireless NIRS flap monitor is capable of detecting StO2 changes resultant from arterial vascular occlusive events. In this porcine flap model, the functionality of this novel sensor closely mirrored that of the T.Ox wired platform. This device is waterproof, highly adhesive, skin conforming, and has sufficient battery life to function for 5 days. Clinical testing is necessary to determine if this wireless functionality translates into fewer false-positive alarms and a better user experience.

Intramuscular Near-Infrared Spectroscopy for Muscle Flap Monitoring in a Porcine Model

2021 ◽  
Author(s):  
Wubin Bai ◽  
Hexia Guo ◽  
Wei Ouyang ◽  
Yang Weng ◽  
Changsheng Wu ◽  
...  
Keyword(s):  
Infrared Spectroscopy ◽  
Oxygen Saturation ◽  
Near Infrared Spectroscopy ◽  
Continuous Monitoring ◽  
Near Infrared ◽  
Muscle Flap ◽  
The Novel ◽  
Skin Paddle ◽  
Free Flap Monitoring ◽  
Flap Monitoring

Abstract Background Current near-infrared spectroscopy (NIRS)-based systems for continuous flap monitoring are limited to flaps which carry a cutaneous paddle. As such, this useful and reliable technology has not previously been applicable to muscle-only free flaps where other modalities with substantial limitations continue to be utilized. Methods We present the first NIRS probe which allows continuous monitoring of local tissue oxygen saturation (StO2) directly within the substance of muscle tissue. This probe is flexible, subcentimeter in scale, waterproof, biocompatible, and is fitted with resorbable barbs which facilitate temporary autostabilization followed by easy atraumatic removal. This novel device was compared with a ViOptix T.Ox monitor in a porcine rectus abdominus myocutaneous flap model of arterial and venous occlusions. During these experiments, the T.Ox device was affixed to the skin paddle, while the novel probe was within the muscle component of the same flap. Results The intramuscular NIRS device and skin-mounted ViOptix T.Ox devices produced very similar StO2 tracings throughout the vascular clamping events, with obvious and parallel changes occurring upon vascular clamping and release. The normalized cross-correlation at zero lag describing correspondence between the novel intramuscular NIRS and T.Ox devices was >0.99. Conclusion This novel intramuscular NIRS probe offers continuous monitoring of oxygen saturation within muscle flaps. This experiment demonstrates the potential suitability of this intramuscular NIRS probe for the task of muscle-only free flap monitoring, where NIRS has not previously been applicable. Testing in the clinical environment is necessary to assess durability and reliability.

Outcomes of free flap reconstructions with near‐infrared spectroscopy (NIRS) monitoring: A systematic review

Microsurgery ◽  
2020 ◽  
Vol 40 (2) ◽  
pp. 268-275 ◽  
Author(s):  
Ethan Newton ◽  
Oleksandr Butskiy ◽  
Babak Shadgan ◽  
Eitan Prisman ◽  
Donald W. Anderson
Keyword(s):  
Systematic Review ◽  
Infrared Spectroscopy ◽  
Near Infrared Spectroscopy ◽  
Free Flap ◽  
Near Infrared

Postoperative Monitoring of Free DIEP Flap in Breast Reconstruction with Near-Infrared Spectroscopy: Variables Affecting the Regional Oxygen Saturation

2018 ◽  
Vol 34 (06) ◽  
pp. 383-388 ◽  
Author(s):  
Marzia Salgarello ◽  
Domenico Pagliara ◽  
Marco Rossi ◽  
Giuseppe Visconti ◽  
Liliana Barone-Adesi
Keyword(s):  
Infrared Spectroscopy ◽  
Breast Reconstruction ◽  
Oxygen Saturation ◽  
Near Infrared Spectroscopy ◽  
Free Flap ◽  
Linear Correlation ◽  
Near Infrared ◽  
Skin Flap ◽  
Diep Flap ◽  
Negative Linear Correlation

Background The timing of surgical reexploration in microanastomotic thrombosis is directly related to the salvage rate of free flap. Near-infrared spectroscopy (NIRS) is a noninvasive technique, which allows a continuous bedside monitoring of flap oxygenation. The current literature is lacking in the assessment of variables able to modify the NIRS monitoring. The aim of this study is to identify patient and flap-related variables that can affect regional oxygen saturation (rSO2). Methods We retrospectively analyzed the data obtained from 45 consecutive patients undergoing breast reconstruction with deep inferior epigastric perforator (DIEP) flap. The monitoring device used is the Somanetics INVOS 5100C Cerebral/Somatic Oximeter (Covidien). Baseline measures of demographic–anthropometric variables (age, weight, height, body mass index [BMI]) and flap factors (flap size in grams, skin flap area in square centimeters, perforator number, and perforator size in millimeters) were collected from preoperative and intraoperative assessment. We investigated the linear correlation between mean rSO2 and BMI, flap size, skin flap area, perforator number, and perforator size. Results A positive linear correlation between rSO2 values and skin flap area, perforator number, and perforator size was found. A negative linear correlation between rSO2 values and BMI and flap size was found. All correlations are statistically significant. Despite the overall negative linear correlation between rSO2 values and flap size, we observed a bimodal trend: a positive relation up to 800 g, which is inverted above 800 g. Conclusion The NIRS is a reliable additional tool in free flap monitoring. A careful evaluation should be given to patients and surgery factors that can change the oximetry data.

scholarly journals New Approach to the Old Challenge of Free Flap Monitoring—Hyperspectral Imaging Outperforms Clinical Assessment by Earlier Detection of Perfusion Failure

2021 ◽  
Vol 11 (11) ◽  
pp. 1101
Author(s):  
Daniel G. E. Thiem ◽  
Paul Römer ◽  
Sebastian Blatt ◽  
Bilal Al-Nawas ◽  
Peer W. Kämmerer
Keyword(s):  
Hyperspectral Imaging ◽  
Free Flap ◽  
Clinical Assessment ◽  
Near Infrared ◽  
Free Flaps ◽  
Clinical Monitoring ◽  
Tissue Oxygen Saturation ◽  
Randomized Clinical Study ◽  
Free Flap Monitoring ◽  
Flap Monitoring

In reconstructive surgery, free flap failure, especially in complex osteocutaneous reconstructions, represents a significant clinical burden. Therefore, the aim of the presented study was to assess hyperspectral imaging (HSI) for monitoring of free flaps compared to clinical monitoring. In a prospective, non-randomized clinical study, patients with free flap reconstruction of the oro-maxillofacial-complex were included. Monitoring was assessed clinically and by using hyperspectral imaging (TIVITA™ Tissue-System, DiaspectiveVision GmbH, Pepelow, Germany) to determine tissue-oxygen-saturation [StO2], near-infrared-perfusion-index [NPI], distribution of haemoglobin [THI] and water [TWI], and variance to an adjacent reference area (Dreference). A total of 54 primary and 11 secondary reconstructions were performed including fasciocutaneous and osteocutaneous flaps. Re-exploration was performed in 19 cases. A total of seven complete flap failures occurred, resulting in a 63% salvage rate. Mean time from flap inset to decision making for re-exploration based on clinical assessment was 23.1 ± 21.9 vs. 18.2 ± 19.4 h by the appearance of hyperspectral criteria indicating impaired perfusion (StO2 ≤ 32% OR StO2Dreference > −38% OR NPI ≤ 32.9 OR NPIDreference ≥ −13.4%) resulting in a difference of 4.8 ± 5 h (p < 0.001). HSI seems able to detect perfusion compromise significantly earlier than clinical monitoring. These findings provide an interpretation aid for clinicians to simplify postoperative flap monitoring.

scholarly journals 1362 Early Experience on Flap Perfusion? Monitoring with Near-Infrared Spectroscopy Tissue Oximetry

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Hagiga ◽  
D Ece Kumbasar ◽  
O Dawood ◽  
J Enrique Berner ◽  
A Blackburn
Keyword(s):  
Infrared Spectroscopy ◽  
Clinical Examination ◽  
Free Flap ◽  
Near Infrared ◽  
Vascular Complications ◽  
Flap Reconstruction ◽  
Success Rates ◽  
Free Flap Monitoring ◽  
Tissue Oximetry ◽  
Flap Perfusion

Abstract Introduction Free flap reconstruction is a routine procedure with more than 99% success rates. Yet, vascular complications may occur leading to flap failure. Thus, early detection of vascular compromise is crucial for flap salvage. Vascular complications may be detected early using Infrared Spectroscopy Tissue Oximetry (NIRS) parameter changes. This method can distinguish changes caused by arterial and venous thrombosis before surgical re-exploration. This study aims to assess the validity or feasibility of using NIRS Oximetry in free flap monitoring and compare it to standard clinical examination and Doppler . Method A prospective cohort observational study. Flap perfusion was measured using the INVOS™ 7100 system for 24-h continuous postoperative monitoring. The data were compared to findings of clinical assessment. Results Ten patients completed the measurements after breast flap reconstruction. Age ranged from 41 to 61 years. Patients underwent immediate d eep inferior epigastric perforators (DIEP) (n = 4), delayed DIEP (n = 4), transverse upper gracilis flap (n = 1), and latissimus dorsi flap with lipofilling (n = 1). All ten flaps are successfully monitored for 24hrs post-operatively. The overall flap survival was 100%. Clinical examination, Doppler studies and surgical outcome were consistent with NIRS (need numbers). There were no false negatives. Conclusions NIRS tissue oximetry could potentially monitor flaps non-invasively. Future adequately sampled cohort study is recommended.

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