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Kleiss SF, Michi M, Schuurman SN, de Vries JPP, Werker PM, de Jongh SJ. Tissue perfusion in DIEP flaps using Indocyanine Green Fluorescence Angiography, Hyperspectral imaging, and Thermal imaging. JPRAS Open 2024; 41:61-74. [PMID: 38948075 PMCID: PMC11214344 DOI: 10.1016/j.jpra.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 04/25/2024] [Indexed: 07/02/2024] Open
Abstract
Flap necrosis continues to occur in skin free flap autologous breast reconstruction. Therefore, we investigated the benefits of indocyanine green angiography (ICGA) using quantitative parameters for the objective, perioperative evaluation of flap perfusion. In addition, we investigated the feasibility of hyperspectral (HSI) and thermal imaging (TI) for postoperative flap monitoring. A single-center, prospective observational study was performed on 15 patients who underwent deep inferior epigastric perforator (DIEP) flap breast reconstruction (n=21). DIEP-flap perfusion was evaluated using ICGA, HSI, and TI using a standardized imaging protocol. The ICGA perfusion curves and derived parameters, HSI extracted oxyhemoglobin (oxyHb) and deoxyhemoglobin (deoxyHb) values, and flap temperatures from TI were analyzed and correlated to the clinical outcomes. Post-hoc quantitative analysis of intraoperatively collected data of ICGA application accurately distinguished between adequately and insufficiently perfused DIEP flaps. ICG perfusion curves identified the lack of arterial inflow (n=2) and occlusion of the venous outflow (n=1). In addition, a postoperatively detected partial flap epidermolysis could have been predicted based on intraoperative quantitative ICGA data. During postoperative monitoring, HSI was used to identify impaired perfusion areas within the DIEP flap based on deoxyHb levels. The results of this study showed a limited added value of TI. Quantitative, post-hoc analysis of ICGA data produced objective and reproducible parameters that enabled the intraoperative detection of arterial and venous congested DIEP flaps. HSI appeared to be a promising technique for postoperative flap perfusion assessment. A diagnostic accuracy study is needed to investigate ICGA and HSI parameters in real-time and demonstrate their clinical benefit.
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Affiliation(s)
- Simone F. Kleiss
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Marlies Michi
- Department of Plastic Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Simone N. Schuurman
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Jean-Paul P.M. de Vries
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Paul M.N. Werker
- Department of Plastic Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Steven J. de Jongh
- Department of Plastic Surgery, University Medical Center Groningen, Groningen, The Netherlands
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Yu H, Yang X, Xie F, Cao G, Tang L. Effect of comfort nursing in the perioperative period of free flap transplantation to repair the defects after surgery for malignant head and neck tumors. Medicine (Baltimore) 2023; 102:e35114. [PMID: 37713903 PMCID: PMC10508440 DOI: 10.1097/md.0000000000035114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 08/16/2023] [Indexed: 09/17/2023] Open
Abstract
To explore the effect of comfort nursing in the perioperative period of free flap transplantation to repair defects of malignant head and neck tumors. This retrospective study included 242 patients with postoperative defects of malignant head and neck tumors repaired using free flap transplantation from December 2017 to December 2022. Among them, 113 patients received routine nursing and were included in the control group, and 129 patients received comfort nursing and were included in the observation group. The perioperative indexes of skin flap transplantation, skin flap necrosis, hospital stay, and cortisol levels were compared. Albumin and pre-albumin levels were compared 1 hour before and 24 hours after surgery. The nursing quality, Self-Rating Depression Scale and Self-Rating Anxiety Scale scores, and nursing satisfaction were compared between the 2 groups. The success rate of skin flap transplantation in the observation group was significantly higher than that in the control group, whereas the rates of skin flap necrosis, length of stay, and cortisol levels were significantly lower in the observation group than in the control group. The Albumin and pre-albumin levels in the observation group were significantly higher than those in the control group 24 hours after surgery. The complication rate was significantly lower in the observation group than in the control group. The Self-Rating Depression Scale and Self-Rating Anxiety Scale scores in the observation group were significantly lower than those in the control group 24 hours after surgery. The satisfaction with nursing was significantly higher in the observation group than in the control group. Comfort nursing improved the success rate of free flap transplantation, reduced complications, reduced stress, improved nutritional, and psychological status of patients during the perioperative period, and improved nursing quality and patient satisfaction with nursing.
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Affiliation(s)
- Haidi Yu
- Department of Head and Neck Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Xishuang Yang
- Department of Head and Neck Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Fei Xie
- Department of Head and Neck Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Guihua Cao
- Department of Head and Neck Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Lina Tang
- Department of Head and Neck Surgery, Harbin Medical University Cancer Hospital, Harbin, China
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Hsu SY, Chen LW, Huang RW, Tsai TY, Hung SY, Cheong DCF, Lu JCY, Chang TNJ, Huang JJ, Tsao CK, Lin CH, Chuang DCC, Wei FC, Kao HK. Quantization of extraoral free flap monitoring for venous congestion with deep learning integrated iOS applications on smartphones: a diagnostic study. Int J Surg 2023; 109:1584-1593. [PMID: 37055021 PMCID: PMC10389505 DOI: 10.1097/js9.0000000000000391] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/28/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND Free flap monitoring is essential for postmicrosurgical management and outcomes but traditionally relies on human observers; the process is subjective and qualitative and imposes a heavy burden on staffing. To scientifically monitor and quantify the condition of free flaps in a clinical scenario, we developed and validated a successful clinical transitional deep learning (DL) model integrated application. MATERIAL AND METHODS Patients from a single microsurgical intensive care unit between 1 April 2021 and 31 March 2022, were retrospectively analyzed for DL model development, validation, clinical transition, and quantification of free flap monitoring. An iOS application that predicted the probability of flap congestion based on computer vision was developed. The application calculated probability distribution that indicates the flap congestion risks. Accuracy, discrimination, and calibration tests were assessed for model performance evaluations. RESULTS From a total of 1761 photographs of 642 patients, 122 patients were included during the clinical application period. Development (photographs =328), external validation (photographs =512), and clinical application (photographs =921) cohorts were assigned to corresponding time periods. The performance measurements of the DL model indicate a 92.2% training and a 92.3% validation accuracy. The discrimination (area under the receiver operating characteristic curve) was 0.99 (95% CI: 0.98-1.0) during internal validation and 0.98 (95% CI: 0.97-0.99) under external validation. Among clinical application periods, the application demonstrates 95.3% accuracy, 95.2% sensitivity, and 95.3% specificity. The probabilities of flap congestion were significantly higher in the congested group than in the normal group (78.3 (17.1)% versus 13.2 (18.1)%; 0.8%; 95% CI, P <0.001). CONCLUSION The DL integrated smartphone application can accurately reflect and quantify flap condition; it is a convenient, accurate, and economical device that can improve patient safety and management and assist in monitoring flap physiology.
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Affiliation(s)
- Shao-Yun Hsu
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, Georgia, USA
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou
- College of Medicine, Chang Gung University
| | | | - Ren-Wen Huang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou
- College of Medicine, Chang Gung University
- Division of Traumatic Plastic Surgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | | | - Shao-Yu Hung
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou
- College of Medicine, Chang Gung University
| | - David Chon-Fok Cheong
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou
- College of Medicine, Chang Gung University
| | - Johnny Chuieng-Yi Lu
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou
- College of Medicine, Chang Gung University
| | - Tommy Nai-Jen Chang
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou
- College of Medicine, Chang Gung University
| | - Jung-Ju Huang
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou
- College of Medicine, Chang Gung University
| | - Chung-Kan Tsao
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou
- College of Medicine, Chang Gung University
| | - Chih-Hung Lin
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou
- College of Medicine, Chang Gung University
| | - David Chwei-Chin Chuang
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou
- College of Medicine, Chang Gung University
| | - Fu-Chan Wei
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou
- College of Medicine, Chang Gung University
| | - Huang-Kai Kao
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou
- College of Medicine, Chang Gung University
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Fingerstall-type Tissue Oximetry Reduced Anxiety of Nurses in Postoperative Nursing Monitoring of Free Flaps. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3991. [PMID: 34938644 PMCID: PMC8687730 DOI: 10.1097/gox.0000000000003991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 10/25/2021] [Indexed: 11/25/2022]
Abstract
Postoperative free flap monitoring is essential for immediately detecting obstruction of anastomosed vessels with successive recovery surgery for salvaging flaps. We performed postoperative nursing monitoring using handheld Doppler sonography, but nurses reported feeling anxious with this approach and demanded a clear-cut evaluation method. Therefore, we implemented monitoring with the fingerstall-type tissue oximeter Toccare, a noninvasive device that enables easy flap checking by simply touching the flap with a probe.
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