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 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.

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

Free Flap Monitoring, Salvage, and Failure Timing: A Systematic Review

2021 ◽  
Author(s):  
Amanda Y. Shen ◽  
Sarah Lonie ◽  
Kaiyang Lim ◽  
Hannah Farthing ◽  
David J. Hunter-Smith ◽  
...  
Keyword(s):  
Free Flap ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Cochrane Library ◽  
Success Rates ◽  
Reliable Technique ◽  
Free Flap Monitoring ◽  
Vascular Compromise ◽  
Flap Monitoring ◽  
Meta Analyses

Abstract Background Microsurgical free tissue transfer has become a reliable technique with success rates around 99% and around 5% requiring exploration for vascular compromise. Protocols for flap monitoring between plastic surgery units vary. We aimed to elucidate the time period when monitoring is crucial for flap salvage. Methods A systematic search of literature was performed in PubMed, Cochrane Library, Medline, and Scopus databases from 1966 to July 2018 according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, identifying 3,844 studies with mention of free flap and monitoring or timing or salvage or compromise. Studies were screened for relevance according to predetermined inclusion criteria. Data was extracted from included studies relating to flap type, monitoring, timing and reason for failure, and success of salvage intervention. Results A total of 109 studies featuring 44,031 free flaps were included. A total of 2,549 (5.8%) flaps required return to theater for compromise; 926 (2.1%) were lost and 1,654 (3.7%) were salvaged. In the first 24 hours postoperatively 93.8% of explored flaps are successfully salvaged, by day 2: 83.33%, day 3: 12.1%, and beyond day 4: none were successful. Of the 355 flaps where the cause of failure was reported, 59.5% was venous, 27.9% was arterial, 2.3% was a combination of both, and 10.2% was hematoma or infection. The proportion of flap failures at various recipient sites was highest in the trunk/viscera (7%, 95% confidence interval [CI] 0.00, 0.36), followed by limbs (5%, 95% CI 0.02, 0.08), head and neck (3%, 95% CI 0.02, 0.04), and breast (<1%; 95% CI 0.00, 0.02). Conclusion Close flap monitoring is of most value in the first 48 hours postoperatively, facilitating rapid detection of vascular compromise, early salvage, and better outcomes. The location of the flap has implications on its success and certain recipient sites may need particular attention to improve chances of success.

scholarly journals Detecting Microsurgical Complications with ViOptix Tissue Oximetry in a Pediatric Myocutaneous Free Flap: Case Presentation and Literature Review

2018 ◽  
Vol 03 (01) ◽  
pp. e8-e12
Author(s):  
Steven Kozusko ◽  
Uzoma Gbulie
Keyword(s):  
Real Time ◽  
Free Flap ◽  
Near Infrared ◽  
Clinical Symptoms ◽  
Tissue Perfusion ◽  
Venous Occlusion ◽  
Tissue Oxygen Saturation ◽  
Real Time Monitoring ◽  
Flap Monitoring ◽  
Tissue Oximetry

Background Microvascular compromise from arterial or venous occlusion is a common cause of free flap failure. The salvage rate following a microvascular compromise is dependent on detecting the problem early and intervening quickly. Methods The ViOptix tissue oximeter measures tissue oxygen saturation using the near-infrared spectroscopy technology. The ViOptix device has an alarm capability to warn of potential compromise to tissue perfusion. The tissue oximetry readings are visible on the bedside monitor and are relayed to a webpage link, which is accessible on a personal computer or mobile device, allowing real-time monitoring. This article presents a case where real-time monitoring allowed almost immediate detection of inadvertent pedicle compromise allowing flap salvage by repositioning without surgical intervention. Results In the case presented, the patient's nurse inadvertently positioned a pillow under the location of the vascular pedicle likely causing microvascular compression. The ViOptix reading dropped and for this reason the nurse contacted the Plastic Surgery team. The drop was confirmed remotely and the flap was urgently evaluated in person. Once the pillow was removed, the ViOptix readings normalized and Doppler signals strengthened in the flap. Discussion While tissue oximetry monitoring does not by itself ensure flap survival, it provides critical information than conventional flap monitoring would allow giving the microsurgeon the opportunity to make a quicker decision. ViOptix tissue oximeters are able to detect vascular compromise even before conventional clinical symptoms are present. Alas in several cases by the time clinical symptoms develop the flap may be beyond salvage.

scholarly journals Noninvasive Free Flap Monitoring Using Eulerian Video Magnification

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Yuan Fang Liu ◽  
Christopher Vuong ◽  
Paul Charles Walker ◽  
Nathaniel Ray Peterson ◽  
Jared Christian Inman ◽  
...  
Keyword(s):  
Operating Room ◽  
Free Flap ◽  
Latissimus Dorsi ◽  
Color Change ◽  
Free Flaps ◽  
Proof Of Concept ◽  
Monitoring Tool ◽  
Naked Eye ◽  
Free Flap Monitoring ◽  
Flap Monitoring

Eulerian Video Magnification (EVM) can enhance subtle changes in videos to reveal what was once invisible to the naked eye. In this proof of concept study, we investigated using EVM as a novel form of free flap monitoring. Free flaps with skin paddles were filmed in the operating room with manipulation of their pedicles. In a representative 77-year-old female who received a latissimus dorsi-serratus-rib composite free flap, EVM was able to detect blockage of arterial or venous supply instantaneously, providing a visible representation through degree of color change in videos. EVM has the potential to serve as a powerful free flap monitoring tool with the benefit of being noninvasive, sensitive, easy-to-use, and nearly cost-free.

scholarly journals Protocolo de avaliação clínica baseado em escore objetivo como preditor de sucesso de retalhos livres e reimplantes

2020 ◽  
Vol 9 (2) ◽  
Author(s):  
Fernanda Ruiz de Andrade ◽  
Rafael Barra Caiado Fleury ◽  
Aleixo Abreu Tanure ◽  
Lauro Toffolo ◽  
Luis Guilherme Rosifini Alves Rezende ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Free Flap ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Current Evidence ◽  
Statistical Computing ◽  
Long Term Outcome ◽  
Tissue Transfer ◽  
Free Flap Monitoring ◽  
Flap Monitoring

Os retalhos microcirúrgicos e reimplantes necessitam de cuidados específicos que devem ser realizados pelo cirurgião desde o momento da sua indicação, até os dias subsequentes à cirurgia. O trabalho em questão abordou à validação do protocolo utilizado pela equipe de um hospital terciário, desde o ano 2016. Os parâmetros clínicos (temperatura, cor, turgor, tempo de enchimento capilar e sangramento à perfuração) geraram um Escore que pode ser capaz de guiar a decisão do profissional, quanto à necessidade de uma reabordagem cirúrgica no período pós-operatório. Foram revisadas 55 tabelas de escores pós-cirúrgicos e correlacionados o escore obtido pelo paciente e o prognóstico da cirurgia, com o objetivo de definir valores de corte estatisticamente significativos para predição do sucesso da mesma, visando compreender à validade do protocolo em guiar a tomada de condutas. Foram determinados os valores de escores de 1 a 8 que definiram o grupo sem necessidade da intervenção cirúrgica; e aqueles superiores a 8 definiram o paciente com um risco de falha da cirurgia e necessidade da intervenção cirúrgica. Por não necessitar de procedimentos invasivos e exames de alta complexidade, o protocolo proposto torna-se uma eficiente ferramenta no diagnóstico precoce de um possível sofrimento vascular do procedimento microcirúrgico.Descritores: Retalhos Cirúrgicos; Reimplante; Microcirurgia; Protocolo Clínico; Cuidados Pós-Operatórios; Exames Médicos.ReferênciasRoehl KR, Mahabir RC. A practical guide to free tissue transfer. Plast Reconstr Surg. 2013;132(1):147-58.Bui DT, Cordeiro PG, Hu QY, Disa JJ, Pusic A, Mehrara BJ. Free flap reexploration: indications, treatment, and outcomes in 1193 free flaps. Plast Reconstr Surg. 2007;119(7):2092-100.Saint-Cyr M, Wong C, Buchel EW. Free tissue transfers and replantation. Plast Reconstr Surg. 2012;130(6):858-78.Salgado CJ, Moran SL, Mardini S. Flap monitoring and patient management. Plast Reconstr Surg. 2009;124(6 Suppl):295-302.Cervenka B, Bewley AF. Free flap monitoring: a review of the recent literature. Curr Opin Otolaryngol Head Neck Surg. 2015;23(5):393-98.Korompilias AV, Lykissas MG, Vekris MD, Beris AE, Soucacos PN. Microsurgery for lower extremity injuries. Injury. 2008;39(Suppl):S103-8.R Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria, 2017. Disponível em: https://www.R-project.org/. Acesso em: 01 jan 2019.Bigdeli AK, Gazyakan E, Schmidt VJ. Long-term outcome after successful lower extremity free flap salvage. J Reconstr Microsurg. 2018;1:1-82.Chae MP, Rozen WM, Whitaker IS. Current evidence for postoperative monitoring of microvascular free flaps: a systematic review. Ann Plast Surg. 2015;74(5):621-32.Hidalgo DA, Jones CS. The role of emergent exploration in free-tissue transfer: a review of 150 consecutive cases. Plast Reconstr Surg. 1990;86(3):499-501.Giunta R, Geisweid A, Feller AM. Clinical classification of free-flap perfusion complications. J Reconstr Microsurg. 2001;17(5):341-45.

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