Paramedian forehead flaps (PMFFs) are commonly performed procedures for the reconstruction of complex nasal defects and require multiple stages predicated on when the interpolated pedicle is no longer required to provide perfusion to the neo-nose. As the presence of the pedicle is disfiguring, the flap is therefore divided ideally as soon as safely possible, but that determination is challenging. Recently, a novel device that uses near-infrared spectroscopy (NIRS) to measure tissue oxygen saturation has been developed and may provide an accurate and cost-effective tool to assess tissue perfusion. Here we present the use of this technology in the management of 2 patients who underwent successful oncologic nasal reconstructions using PMFFs. Using the device as a clinical adjunct, we measured tissue oxygen saturation values in the flaps before and after pedicle division, which assisted us in deciding when to safely divide the flaps, as well as with post-division management, particularly when a low tissue oxygen saturation reading ultimately necessitated the use of nitroglycerine past to improve flap perfusion in one of our patients. Interestingly, the values we recorded corresponded well to previously published cut-off values for adequate tissue perfusion, which have to date only been reported for free flaps. To our knowledge, this is the first description of the use of NIRS in the division of PMFFs, which we overall found to be a useful and reliable adjunct to a clinical examination in assessing flap neovascularization.
Near-infrared spectroscopy monitoring tissue oxygen saturation after cardiac surgery
