Early detection and differentiation of venous and arterial occlusion in skin flaps using visible diffuse reflectance spectroscopy and autofluorescence spectroscopy

Measurement of optical reflection and temperature changes after blood occlusion using a wearable device

Early detection of compromised circulation is essential for postoperative monitoring of free flap. Hourly clinical check-ups such as inspection and palpation still result in a delay in detection. Conversely, optical reflection and temperature measurement are useful alternatives for detecting blood circulation. However, conventional methods that verify ischemia and congestion within a short period have not been reported. In this study, we measured short-term changes in optical reflection and temperature in a rat flap using a wearable flexible sensor probe previously developed in our laboratory. Five ischemia and five congestion groin flap models were measured using a sensor probe and reference devices. Curve fitting was performed on transition signals to evaluate changes in signals and their time constants. The optical reflection signal decreased after venous ligation and increased after arterial ligation. The parameters of the fitted curves indicate a significant difference between congestion and ischemia at p < 0.01 (probability value), which was detected within a few minutes after ligation. However, insufficient significance was observed in the temperature signal. Our method gives supporting information to verify ischemia and congestion, and has the potential to rapidly detect compromised circulation.

Design and development of portable handheld multimodal spectroscopic probe system for skin tissue analysis

The potential of optical spectroscopic techniques such as diffused reflectance and fluorescence as non-invasive, in vivo diagnostic tools is being explored and validated recently. In this paper, we present the design and development of a handheld, portable, multimodal fiber optic based probe scheme to sequentially measure diffuse reflectance and fluorescence. The proposed prototype is designed to sequentially acquire diffused reflectance in the broad wavelength range of 400 nm-1600 nm and fluorescence using custom-chosen spectrophotometers, monochromatic and broadband light sources, fibers to accommodate a wide wavelength range, custom-built probe distal end, and a real-time spectral stitching and display unit. The prototype is characterized using in-house fabricated phantom tissue samples with tunable optical properties such as scattering and absorption. The depth profile study is carried out using phantom tissue layers of known optical parameters followed by the sequential measurement of diffused reflectance and fluorescence from the tissue mimicking sample.

Fast pulsatile blood flow measurement in deep tissue through a multimode detection fiber

SIGNIFICANCE

Noninvasive in vivo fast pulsatile blood flow measurement in deep tissue is important because the blood flow waveform is correlated with physiological parameters, such as blood pressure and elasticity of blood vessels. Compromised blood flow may cause diseases, such as stroke, foot ulcer, and myocardial ischemia. There is great clinical demand for a portable and cost-effective device for noninvasive pulsatile blood flow measurement.

AIM

A diffuse-optics-based method, diffuse speckle pulsatile flowmetry (DSPF), was developed for fast measurement (∼300  Hz) of deep tissue blood flow noninvasively. To validate its performance, both a phantom experiment and in vivo demonstration were conducted.

APPROACH

Over the past two decades, single-mode fibers have been used as detection fibers in most diffuse-optics-based deep tissue blood flow measurement modalities. We used a multimode (MM) detection fiber with a core size of 200  μm for diffused speckle pattern detection. A background intensity correction algorithm was implemented for speckle contrast calculation. The MM detection fiber helped to achieve a level of deep tissue blood flow measurement similar to that of conventional modalities, such as diffuse correlation spectroscopy and diffuse speckle contrast analysis, but it increases the measurement rate of blood flow to 300 Hz.

RESULTS

The design and implementation of the DSPF system were introduced. The theory of the background intensity correction for the diffused speckle pattern detected by the MM fiber was explained. A flow phantom was built for validation of the performance of the DSPF system. An in vivo cuff-induced occlusion experiment was performed to demonstrate the capability of the proposed DSPF system.

CONCLUSIONS

An MM detection fiber can help to achieve fast (∼300  Hz) pulsatile blood flow measurement in the proposed DSPF method. The cost-effective device and the fiber-based flexible probe increase the usability of the DSPF system significantly.

Spectral diffuse reflectance and autofluorescence imaging can perform early prediction of blood vessel occlusion in skin flaps

Flap transfer has become a common technique in reconstructive surgery. However, a significant number of compromised skin flaps are not successfully salvaged because the current clinical method for flap assessment relies heavily on the clinician's experience. Vascular occlusion is the major reason for flap failure, thus the accurate and objective early prediction of blood vessel occlusion is vitally important. Our parallel point measurement study has demonstrated the great potential of joint diffuse reflectance and autofluorescence spectroscopy in the early detection and differentiation of venous and arterial occlusion in skin flaps. Unfortunately, the technique of point measurements is not suitable to examine a large skin flap when a high spatial resolution is required. In this study, we attempted to overcome this problem by performing spectral diffuse reflectance and autofluorescence imaging on a rat skin flap model. Both imaging data and reconstructed spectra were used to statistically differentiate control flaps, arterially occluded flaps and venously occluded flaps. Our preliminary results suggest that the technique of joint diffuse reflectance and autofluorescence spectroscopic imaging can achieve high classification accuracy thus could be used to detect and differentiate flaps with venous and arterial occlusion accurately at an early time point in a large skin flap. Typical reconstructed spectra of (a) diffuse reflectance and (b) autofluorescence after normalization.

Compact dual-mode diffuse optical system for blood perfusion monitoring in a porcine model of microvascular tissue flaps

In reconstructive surgery, the ability to detect blood flow interruptions to grafted tissue represents a critical step in preventing postsurgical complications. We have developed and pilot tested a compact, fiber-based device that combines two complimentary modalities-diffuse correlation spectroscopy (DCS) and diffuse reflectance spectroscopy-to quantitatively monitor blood perfusion. We present a proof-of-concept study on an in vivo porcine model (n=8). With a controllable arterial blood flow supply, occlusion studies (n=4) were performed on surgically isolated free flaps while the device simultaneously monitored blood flow through the supplying artery as well as flap perfusion from three orientations: the distal side of the flap and two transdermal channels. Further studies featuring long-term monitoring, arterial failure simulations, and venous failure simulations were performed on flaps that had undergone an anastomosis procedure (n=4). Additionally, benchtop verification of the DCS system was performed on liquid flow phantoms. Data revealed relationships between diffuse optical measures and state of occlusion as well as the ability to detect arterial and venous compromise. The compact construction of the device, along with its noninvasive and quantitative nature, would make this technology suitable for clinical translation.

Autofluorescence spectroscopy for nerve-sparing laser surgery of the head and neck-the influence of laser-tissue interaction

The use of remote optical feedback systems represents a promising approach for minimally invasive, nerve-sparing laser surgery. Autofluorescence properties can be exploited for a fast, robust identification of nervous tissue. With regard to the crucial step towards clinical application, the impact of laser ablation on optical properties in the vicinity of structures of the head and neck has not been investigated up to now. We acquired 24,298 autofluorescence spectra from 135 tissue samples (nine ex vivo tissue types from 15 bisected pig heads) both before and after ER:YAG laser ablation. Sensitivities, specificities, and area under curve(AUC) values for each tissue pair as well as the confusion matrix were statistically calculated for pre-ablation and post-ablation autofluorescence spectra using principal component analysis (PCA), quadratic discriminant analysis (QDA), and receiver operating characteristics (ROC). The confusion matrix indicated a highly successful tissue discrimination rate before laser exposure, with an average classification error of 5.2%. The clinically relevant tissue pairs nerve/cancellous bone and nerve/salivary gland yielded an AUC of 100% each. After laser ablation, tissue discrimination was feasible with an average classification accuracy of 92.1% (average classification error 7.9%). The identification of nerve versus cancellous bone and salivary gland performed very well with an AUC of 100 and 99%, respectively. Nerve-sparing laser surgery in the area of the head and neck by means of an autofluorescence-based feedback system is feasible even after ER-YAG laser-tissue interactions. These results represent a crucial step for the development of a clinically applicable feedback tool for laser surgery interventions in the oral and maxillofacial region.

Intraoperative video-rate hemodynamic response assessment in human cortex using snapshot hyperspectral optical imaging

Using light, we are able to visualize the hemodynamic behavior of the brain to better understand neurovascular coupling and cerebral metabolism. In vivo optical imaging of tissue using endogenous chromophores necessitates spectroscopic detection to ensure molecular specificity as well as sufficiently high imaging speed and signal-to-noise ratio, to allow dynamic physiological changes to be captured, isolated, and used as surrogate of pathophysiological processes. An optical imaging system is introduced using a 16-bands on-chip hyperspectral camera. Using this system, we show that up to three dyes can be imaged and quantified in a tissue phantom at video-rate through the optics of a surgical microscope. In vivo human patient data are presented demonstrating brain hemodynamic response can be measured intraoperatively with molecular specificity at high speed.