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Kim H, Kwak SH, Byeon JY, Lee DW, Kim JH, Lim S, Choi HJ. An Experimental and Clinical Study of Flap Monitoring with an Analysis of the Clinical Course of the Flap Using an Infrared Thermal Camera. Bioengineering (Basel) 2024; 11:688. [PMID: 39061770 PMCID: PMC11273470 DOI: 10.3390/bioengineering11070688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 07/03/2024] [Accepted: 07/05/2024] [Indexed: 07/28/2024] Open
Abstract
Flap surgery is a common method used to cover defects following tumor ablation, trauma, or infection. However, insufficient vascularity in the transferred flap can lead to flap necrosis and failure. Proper postoperative monitoring is essential to prevent these complications. Recently, research has explored the use of infrared thermal imaging in plastic surgery, leading to its clinical application. This study comprises two separate parts: an in vivo experimental study and a clinical study. In this study, 28 rats underwent reverse McFarlane flap surgery, and their flaps were analyzed using a FLIR thermal imaging camera seven days post-surgery. Additionally, thermal images of flaps were taken on postoperative days 0, 1, 2, 3, and 7 in 22 patients. This study focused on temperature differences between normal skin and the perforator compared to the average flap temperature. Results showed that the temperature difference was higher in the necrosis group and increased over time in cases of total necrosis. A lower perforator temperature compared to the flap's average indicated vascular compromise, potentially leading to flap failure. The FLIR camera, being contact-free and convenient, shows promise for understanding and inferring the clinical progression of flaps in postoperative monitoring.
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Affiliation(s)
- Hyun Kim
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Republic of Korea; (H.K.); (S.H.K.); (J.Y.B.); (D.W.L.); (J.H.K.)
| | - Si Hyun Kwak
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Republic of Korea; (H.K.); (S.H.K.); (J.Y.B.); (D.W.L.); (J.H.K.)
| | - Je Yeon Byeon
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Republic of Korea; (H.K.); (S.H.K.); (J.Y.B.); (D.W.L.); (J.H.K.)
| | - Da Woon Lee
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Republic of Korea; (H.K.); (S.H.K.); (J.Y.B.); (D.W.L.); (J.H.K.)
| | - Jun Hyuk Kim
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Republic of Korea; (H.K.); (S.H.K.); (J.Y.B.); (D.W.L.); (J.H.K.)
| | - Soomin Lim
- Bachelor of Medicine and Bachelor of Surgery (MBBS), UCL Medical School, University College London, London WC1E 6BT, UK;
| | - Hwan Jun Choi
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Republic of Korea; (H.K.); (S.H.K.); (J.Y.B.); (D.W.L.); (J.H.K.)
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Sorotos M, Firmani G, Tornambene R, Marrella D, Paolini G, Santanelli di Pompeo F. DIEP flap perfusion assessment using microdialysis versus Doppler ultrasonography: A comparative study. Microsurgery 2024; 44:e31097. [PMID: 37538001 DOI: 10.1002/micr.31097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 06/03/2023] [Accepted: 07/21/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND The increasing number of buried free-tissue transfer procedures and the need for an objective method to evaluate vascular complications of free flaps has led to the development of new technologies. Microdialysis has been used to monitor free flaps using interstitial biological markers. Previous uses mainly focused on muscular flaps. Our aim is to compare external Doppler ultrasonography (EDU) evaluation versus microdialysis in the early follow-up of adipocutaneous flaps, and propose an efficient postoperative monitoring protocol. METHODS We retrospectively assessed 68 consecutive DIEP flaps (50 patients) performed between January 2019 and March 2021. All flaps received standardized post-operative monitoring using clinical signs, EDU and microdialysis. Glucose and lactate concentrations were assessed using glucose <1 mmol/L and lactate >6 mmol/L as ischemic trend thresholds. We calculated Glucose/Lactate ratio as a new parameter for the assessment of flap viability. RESULTS Among all the 68 flaps, two flaps returned to the operative theater when a combination of unsatisfactory microdialysis values and clinical/EDU signs identified vascular impairment; only one developed total flap necrosis. Reoperation rate was 2.94% with an overall flap success rate of 98.53%. External Doppler ultrasonography had 100% sensitivity and 82% specificity, while microdialysis had 100% sensitivity and 100% specificity. CONCLUSIONS Microdialysis values proved flap viability sooner than external Doppler ultrasonography, making it an excellent tool for post-operative monitoring. With the appropriate thresholds for glucose and lactate concentrations, and glucose/lactate ratio used as a new parameter, it can help potentially avoiding unnecessary re-explorations, and reducing flap ischemia times.
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Affiliation(s)
- Michail Sorotos
- Faculty of Medicine and Psychology, Sapienza University of Rome - Sant'Andrea Hospital, Rome, Italy
| | - Guido Firmani
- Faculty of Medicine and Psychology, Sapienza University of Rome - Sant'Andrea Hospital, Rome, Italy
| | - Roberta Tornambene
- Department of Human Pathology, Division and Residency Program in Plastic, Reconstructive and Aesthetic Surgery, University of Messina, Messina, Italy
| | - Domenico Marrella
- Department of Human Pathology, Division and Residency Program in Plastic, Reconstructive and Aesthetic Surgery, University of Messina, Messina, Italy
| | - Guido Paolini
- Faculty of Medicine and Psychology, Sapienza University of Rome - Sant'Andrea Hospital, Rome, Italy
| | - Fabio Santanelli di Pompeo
- Faculty of Medicine and Psychology, Sapienza University of Rome - Sant'Andrea Hospital, Rome, Italy
- Chair of Plastic Surgery, Faculty of Medicine and Psychology, Sapienza University of Rome - Sant'Andrea Hospital, Rome, Italy
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Ooms M, Winnand P, Heitzer M, Peters F, Bock A, Katz MS, Hölzle F, Modabber A. Attached compared with unattached surface probes for monitoring flap perfusion in microvascular head and neck reconstruction: a feasibility study. Sci Rep 2023; 13:15939. [PMID: 37743387 PMCID: PMC10518317 DOI: 10.1038/s41598-023-43151-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 09/20/2023] [Indexed: 09/26/2023] Open
Abstract
Unattached surface probes are commonly used with the O2C analysis system (LEA Medizintechnik, Germany) to monitor microvascular free flap perfusion. This study compared attached and unattached surface probes for extraoral free flaps. The study included 34 patients who underwent extraoral microvascular head and neck reconstruction between 2020 and 2022. Flap perfusion was monitored postoperatively using the O2C analysis system at 0, 12, 24, 36, and 48 h, with an attached surface probe at 3 mm tissue depth and an unattached surface probe at 2 mm and 8 mm tissue depths. Clinical complications, technical errors, and perfusion measurement values were compared. No clinical complications (attachment suture infections) or technical errors (probe detachment) occurred. Flap blood flow values of the probes were partially different (3 mm vs. 2 and 8 mm: p < 0.001; p = 0.308) and moderately correlated (3 mm with 2 and 8 mm: r = 0.670, p < 0.001; r = 0.638, p < 0.001). Hemoglobin concentration and oxygen saturation values were generally different (3 mm vs. 2 and 8 mm: all p < 0.001) and variably correlated (3 mm with 2 and 8 mm: r = 0.756, r = 0.645; r = 0.633, r = 0.307; all p < 0.001). Both probes are comparable in terms of technical feasibility and patient safety, with flap perfusion values dependent on tissue measurement depth.
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Affiliation(s)
- Mark Ooms
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Philipp Winnand
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Marius Heitzer
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Florian Peters
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Anna Bock
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Marie Sophie Katz
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Frank Hölzle
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Ali Modabber
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
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Singh K, Shah S, Mittal RK, Garg R. Role of Lactate Measurement in Flap Monitoring: An Useful Adjunct. Indian J Plast Surg 2023; 56:344-349. [PMID: 37705814 PMCID: PMC10497328 DOI: 10.1055/s-0043-1769111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023] Open
Abstract
Background Detection of vascular compromise in flap is often a challenging task for reconstructive surgeons. A timely salvage procedure depends on objectivity and reliability of postoperative flap monitoring. This study determined if flap capillary lactate helps in prediction of flap viability in first 48 postoperative hours of surgery. Methods We conducted this study on all flaps with accessible skin paddle where capillary lactate values were assessed along with clinical observation to check viability of flap at 0, 1, 6, 12, 24 and 48 hours of surgery. The data was statistically analyzed for significance and area under the receiver operating characteristic curve was used for calculating cutoff value for lactate. Results Out of a total of 30 patients included in this study, 25 were males and the mean age was 45.03 years. Fifteen patients underwent free flap and rest pedicled. Highly significant association of role of clinical observation in the outcome of flap was found. The average of lactate values for survived and distally ischemic flap was 5.32 ± 1.91 and 8.38 ± 1.81, respectively, which was highly significant. The cutoff value of lactate below which all flaps survived was found to be 6.09 mmol/L. Conclusion Flap capillary lactate measurement is an easy, quick, cost-effective, and objective tool for checking viability of flaps.
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Affiliation(s)
- Karan Singh
- Department of Plastic Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Sheerin Shah
- Department of Plastic Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Rajinder K. Mittal
- Department of Plastic Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Ramneesh Garg
- Department of Plastic Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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Lu D, Moritz W, Arafa HM, Yang Q, Jacobson L, Ostojich D, Bai W, Guo H, Wu C, Li S, Li S, Huang Y, Xu Y, Yan Y, Westman AM, MacEwan MR, Rogers JA, Pet MA. Intramuscular Microvascular Flow Sensing for Flap Monitoring in a Porcine Model of Arterial and Venous Occlusion. J Reconstr Microsurg 2023; 39:231-237. [PMID: 35952677 DOI: 10.1055/s-0042-1755261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
BACKGROUND Commercially available near infrared spectroscopy devices for continuous free flap tissue oxygenation (StO2) monitoring can only be used on flaps with a cutaneous component. Additionally, differences in skin quality and pigmentation may alter StO2 measurements. Here, we present a novel implantable heat convection probe that measures microvascular blood flow for peripheral monitoring of free flaps, and is not subject to the same issues that limit the clinical utility of near-infrared spectroscopy. METHODS The intratissue microvascular flow-sensing device includes a resistive heater, 4 thermistors, a small battery, and a Bluetooth chip, which allows connection to a smart device. Convection of applied heat is measured and mathematically transformed into a measurement of blood flow velocity. This was tested alongside Vioptix T.Ox in a porcine rectus abdominis myocutaneous flap model of arterial and venous occlusion. After flap elevation, the thermal device was deployed intramuscularly, and the cutaneous T.Ox device was applied. Acland clamps were alternately applied to the flap artery and veins to achieve 15 minutes periods of flap ischemia and congestion with a 15 minutes intervening recovery period. In total, five devices were tested in three flaps in three separate pigs over 16 vaso-occlusive events. RESULTS Flow measurements were responsive to both ischemia and congestion, and returned to baseline during recovery periods. Flow measurements corresponded closely with measured StO2. Cross-correlation at zero lag showed agreement between these two sensing modalities. Two novel devices tested simultaneously on the same flap showed only minor variations in flow measurements. CONCLUSION This novel probe is capable of detecting changes in tissue microcirculatory blood flow. This device performed well in a swine model of flap ischemia and congestion, and shows promise as a potentially useful clinical tool. Future studies will investigate performance in fasciocutaneous flaps and characterize longevity of the device over a period of several days.
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Affiliation(s)
- Di Lu
- Center of Bio-Integrated Electronics, Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois
| | - William Moritz
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University, St. Louis, Missouri
| | - Hany M Arafa
- Center of Bio-Integrated Electronics, Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois
| | - Quansan Yang
- Center of Bio-Integrated Electronics, Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois
| | - Lauren Jacobson
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University, St. Louis, Missouri
| | - Diana Ostojich
- Center of Bio-Integrated Electronics, Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois
| | - Wubin Bai
- Department of Applied Physical Sciences, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Hexia Guo
- Center of Bio-Integrated Electronics, Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois
| | - Changsheng Wu
- Center of Bio-Integrated Electronics, Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois
| | - Shuo Li
- Center of Bio-Integrated Electronics, Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois
| | - Shupeng Li
- Department of Mechanical Engineering, Northwestern University, Evanston, Illinois
| | - Yonggang Huang
- Department of Mechanical Engineering, Northwestern University, Evanston, Illinois
| | - Yameng Xu
- Department of Neurosurgery, School of Medicine, Washington University, St. Louis, Missouri
| | - Ying Yan
- Department of Neurosurgery, School of Medicine, Washington University, St. Louis, Missouri
| | - Amanda M Westman
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University, St. Louis, Missouri
| | - Matthew R MacEwan
- Department of Neurosurgery, School of Medicine, Washington University, St. Louis, Missouri
| | - John A Rogers
- Center of Bio-Integrated Electronics, Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois
| | - Mitchell A Pet
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University, St. Louis, Missouri
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Knoedler S, Hoch CC, Huelsboemer L, Knoedler L, Stögner VA, Pomahac B, Kauke-Navarro M, Colen D. Postoperative free flap monitoring in reconstructive surgery-man or machine? Front Surg 2023; 10:1130566. [PMID: 36911625 PMCID: PMC9992807 DOI: 10.3389/fsurg.2023.1130566] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 02/07/2023] [Indexed: 02/24/2023] Open
Abstract
Free tissue transfer is widely used for the reconstruction of complex tissue defects. The survival of free flaps depends on the patency and integrity of the microvascular anastomosis. Accordingly, the early detection of vascular comprise and prompt intervention are indispensable to increase flap survival rates. Such monitoring strategies are commonly integrated into the perioperative algorithm, with clinical examination still being considered the gold standard for routine free flap monitoring. Despite its widespread acceptance as state of the art, the clinical examination also has its pitfalls, such as the limited applicability in buried flaps and the risk of poor interrater agreement due to inconsistent flap (failure) appearances. To compensate for these shortcomings, a plethora of alternative monitoring tools have been proposed in recent years, each of them with inherent strengths and limitations. Given the ongoing demographic change, the number of older patients requiring free flap reconstruction, e.g., after cancer resection, is rising. Yet, age-related morphologic changes may complicate the free flap evaluation in elderly patients and delay the prompt detection of clinical signs of flap compromise. In this review, we provide an overview of currently available and employed methods for free flap monitoring, with a special focus on elderly patients and how senescence may impact standard free flap monitoring strategies.
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Affiliation(s)
- Samuel Knoedler
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
- Department of Surgery, Division of Plastic Surgery, Yale School of Medicine, Yale New Haven Hospital,New Haven, CT, United States
- Correspondence: Samuel Knoedler Martin Kauke-Navarro
| | - Cosima C. Hoch
- Department of Otolaryngology, Head and Neck Surgery, Rechts der Isar Hospital, Technical University Munich, Munich, Germany
| | - Lioba Huelsboemer
- Department of Surgery, Division of Plastic Surgery, Yale School of Medicine, Yale New Haven Hospital,New Haven, CT, United States
| | - Leonard Knoedler
- Department of Surgery, Division of Plastic Surgery, Yale School of Medicine, Yale New Haven Hospital,New Haven, CT, United States
| | - Viola A. Stögner
- Department of Surgery, Division of Plastic Surgery, Yale School of Medicine, Yale New Haven Hospital,New Haven, CT, United States
| | - Bohdan Pomahac
- Department of Surgery, Division of Plastic Surgery, Yale School of Medicine, Yale New Haven Hospital,New Haven, CT, United States
| | - Martin Kauke-Navarro
- Department of Surgery, Division of Plastic Surgery, Yale School of Medicine, Yale New Haven Hospital,New Haven, CT, United States
- Correspondence: Samuel Knoedler Martin Kauke-Navarro
| | - David Colen
- Department of Surgery, Division of Plastic Surgery, Yale School of Medicine, Yale New Haven Hospital,New Haven, CT, United States
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Bassani S, Eccher A, Molteni G. Harnessing the Power of Artificial Intelligence: Revolutionizing Free Flaps Monitoring in Head and Neck Tumor Treatment. Crit Rev Oncog 2023; 28:25-30. [PMID: 37968990 DOI: 10.1615/critrevoncog.2023049158] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
Treating head and neck tumors has undergone significant advancements, focusing on improving the patient's quality of life after treatment. Reconstructive surgical techniques with free flaps have been vital in restoring anatomy, function, and aesthetics, reducing morbidity from locoregional treatments. Monitoring free flaps is crucial to detect and address any vascular compromise that may lead to flap failure. Various monitoring techniques have been employed in free flap monitoring. However, standardizing them presents a challenge due to the need for more consensus among surgeons and variability in techniques, costs, and training requirements. Artificial intelligence (AI) shows promise in standardizing monitoring practices and reducing the operator-dependent variability. AI techniques have been explored to improve monitoring and early detection of complications in free flap surgeries, and they have shown high accuracy in analyzing images and predicting flap outcomes. Despite the potential benefits, implementing AI in free flap monitoring remains challenging. Standardization of input data, interpretation, cost, training, and accounting for patient and flap variability are crucial considerations. Further research, including multicenter studies, validation, and collaboration amongst clinicians, researchers, and AI experts is needed to overcome these challenges.
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Affiliation(s)
- Sara Bassani
- Otolaryngology-Head and Neck Surgery Department, University of Verona, Verona, Italy
| | - Albino Eccher
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - Gabriele Molteni
- Department of Otorhinolaryngology, Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
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High-speed, scanned laser structuring of multi-layered eco/bioresorbable materials for advanced electronic systems. Nat Commun 2022; 13:6518. [PMID: 36316354 PMCID: PMC9622701 DOI: 10.1038/s41467-022-34173-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
Physically transient forms of electronics enable unique classes of technologies, ranging from biomedical implants that disappear through processes of bioresorption after serving a clinical need to internet-of-things devices that harmlessly dissolve into the environment following a relevant period of use. Here, we develop a sustainable manufacturing pathway, based on ultrafast pulsed laser ablation, that can support high-volume, cost-effective manipulation of a diverse collection of organic and inorganic materials, each designed to degrade by hydrolysis or enzymatic activity, into patterned, multi-layered architectures with high resolution and accurate overlay registration. The technology can operate in patterning, thinning and/or cutting modes with (ultra)thin eco/bioresorbable materials of different types of semiconductors, dielectrics, and conductors on flexible substrates. Component-level demonstrations span passive and active devices, including diodes and field-effect transistors. Patterning these devices into interconnected layouts yields functional systems, as illustrated in examples that range from wireless implants as monitors of neural and cardiac activity, to thermal probes of microvascular flow, and multi-electrode arrays for biopotential sensing. These advances create important processing options for eco/bioresorbable materials and associated electronic systems, with immediate applicability across nearly all types of bioelectronic studies.
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Becker P, Blatt S, Pabst A, Heimes D, Al-Nawas B, Kämmerer PW, Thiem DGE. Comparison of Hyperspectral Imaging and Microvascular Doppler for Perfusion Monitoring of Free Flaps in an In Vivo Rodent Model. J Clin Med 2022; 11:jcm11144134. [PMID: 35887901 PMCID: PMC9321983 DOI: 10.3390/jcm11144134] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 01/27/2023] Open
Abstract
To reduce microvascular free flap failure (MFF), monitoring is crucial for the early detection of malperfusion and allows timely salvage. Therefore, the aim of this study was to evaluate hyperspectral imaging (HSI) in comparison to micro-Doppler sonography (MDS) to monitor MFF perfusion in an in vivo rodent model. Bilateral groin flaps were raised on 20 Sprague−Dawley rats. The femoral artery was transected on the trial side and re-anastomosed. Flaps and anastomoses were assessed before, during, and after the period of ischemia every ten minutes for overall 60 min using HSI and MDS. The contralateral sides’ flaps served as controls. Tissue-oxygenation saturation (StO2), near-infrared perfusion index (NPI), hemoglobin (THI), and water distribution (TWI) were assessed by HSI, while blood flow was assessed by MDS. HSI correlates with the MDS signal in the case of sufficient and completely interrupted perfusion. HSI was able to validly and reproducibly detect tissue perfusion status using StO2 and NPI. After 40 min, flap perfusion decreased due to the general aggravation of hemodynamic circulatory situation, which resulted in a significant drop of StO2 (p < 0.005) and NPI (p < 0.005), whereas the Doppler signal remained unchanged. In accordance, HSI might be suitable to detect MFF general complications in an early stage and further decrease MFF failure rates, whereas MDS may only be used for direct complications at the anastomose site.
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Affiliation(s)
- Philipp Becker
- Department of Oral and Maxillofacial Surgery, Federal Armed Forces Hospital, Rübenacherstr. 170, 56072 Koblenz, Germany;
- Department of Oral and Maxillofacial Surgery, University Medical Centre Mainz, 55131 Mainz, Germany; (S.B.); (D.H.); (B.A.-N.); (P.W.K.); (D.G.E.T.)
- Correspondence:
| | - Sebastian Blatt
- Department of Oral and Maxillofacial Surgery, University Medical Centre Mainz, 55131 Mainz, Germany; (S.B.); (D.H.); (B.A.-N.); (P.W.K.); (D.G.E.T.)
| | - Andreas Pabst
- Department of Oral and Maxillofacial Surgery, Federal Armed Forces Hospital, Rübenacherstr. 170, 56072 Koblenz, Germany;
- Department of Oral and Maxillofacial Surgery, University Medical Centre Mainz, 55131 Mainz, Germany; (S.B.); (D.H.); (B.A.-N.); (P.W.K.); (D.G.E.T.)
| | - Diana Heimes
- Department of Oral and Maxillofacial Surgery, University Medical Centre Mainz, 55131 Mainz, Germany; (S.B.); (D.H.); (B.A.-N.); (P.W.K.); (D.G.E.T.)
| | - Bilal Al-Nawas
- Department of Oral and Maxillofacial Surgery, University Medical Centre Mainz, 55131 Mainz, Germany; (S.B.); (D.H.); (B.A.-N.); (P.W.K.); (D.G.E.T.)
| | - Peer W. Kämmerer
- Department of Oral and Maxillofacial Surgery, University Medical Centre Mainz, 55131 Mainz, Germany; (S.B.); (D.H.); (B.A.-N.); (P.W.K.); (D.G.E.T.)
| | - Daniel G. E. Thiem
- Department of Oral and Maxillofacial Surgery, University Medical Centre Mainz, 55131 Mainz, Germany; (S.B.); (D.H.); (B.A.-N.); (P.W.K.); (D.G.E.T.)
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Matsui C, Lao WW, Tanaka T, Escandón JM, Mohammad A, Tsuji N, Matsui Y, Mizuno H. Dynamic Changes on Video-capillaroscopy and Potential Microsurgical Application: Temperature and Skin Surface Readings. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4265. [PMID: 35441066 PMCID: PMC9010126 DOI: 10.1097/gox.0000000000004265] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 02/28/2022] [Indexed: 11/25/2022]
Abstract
Video-capillaroscopy is being explored as a potential tool for microsurgical flap monitoring. A detailed examination of the effect of temperature on capillary changes using video-capillaroscopy is yet to be investigated. We analyzed the video-capillaroscopy findings on different skin areas often used for flap harvest at normal body temperatures and at lower temperatures. Skin capillaries at the lateral thigh, anterior forearm, mid-axillary line, abdomen, and fingertips were observed using video-capillaroscopy in 20 healthy Japanese individuals. Further, ImageJ software was used to measure the blood vessel area and blood flow velocity, and comparisons were drawn between normal body temperature and lower body temperature states. All measures of blood vessel area and average blood flow velocity for the different anatomical regions were significantly different before and after cooling (P < 0.001). The mean reduction rate of the vessel area was significantly different among anatomic regions (P < 0.001). Post-hoc analysis revealed a significant difference in the vessel area reduction rate between anatomic areas (P < 0.05); except when comparing the thigh versus finger, the forearm versus abdomen, and the mid-axillary line versus abdomen. The mean blood flow velocity was significantly different among anatomic regions (P < 0.001). Post-hoc analysis revealed a significant difference between the thigh and forearm (P = 0.009), the forearm and fingertip (P = 0.001), and the abdomen and fingertip (P = 0.004). Decreasing the skin temperature resulted in a significant vasoconstriction and reduction in capillary flow velocity. It is imperative to keep the monitored area warm during video-capillaroscopy assessment to avoid false diagnosis of vascular occlusion.
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Affiliation(s)
- Chihiro Matsui
- From the Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | | | - Takakuni Tanaka
- Department of Oral and Maxillofacial Surgery, Toyooka Public Hospital, Hyogo, Japan
| | - Joseph M. Escandón
- Division of Plastic and Reconstructive Surgery, University of Rochester Medical Center, Strong Memorial Hospital, New York, N.Y
| | - Arbab Mohammad
- Aarupadai Veedu Medical College and Hospital, Puducherry, India
| | - Nao Tsuji
- Department of Plastic and Aesthetic Surgery, LULA Beauty Clinic, Tokyo, Japan
| | - Yuki Matsui
- Department of Urology, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Hiroshi Mizuno
- From the Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan
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11
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Evaluation of Predictive Values of an Automatic Device Measuring Oximetry in Free Flaps. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3819. [PMID: 34584825 PMCID: PMC8460219 DOI: 10.1097/gox.0000000000003819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/26/2021] [Indexed: 11/26/2022]
Abstract
Free-flap monitoring is challenging to perform in some centers. It requires the availability of trained health care personnel for 24 hours a day and seven days a week. Many methods had been proposed for flap monitoring, and none of them are superior to clinical evaluation. This study aimed to present a murine model to evaluate the accuracy (sensitivity, specificity, and the positive or negative predictive values) of a device. Wistar rats weighing 240–490 g were included for intervention and data collection. A murine model of left inferior epigastric vessel flaps was implemented. Intermittent pedicle clamping was performed to calculate the accuracy of the device that detects flow obstruction. The general variables studied were age, weight, and gender. The sensitivity, specificity, and negative or predictive values were calculated. The results showed a sensitivity of 97%, a specificity of 95% with a positive predictive value of 95%, and negative predictive value of 97%. The sensitivity and specificity showed excellent results within the range of clinical security. We require more data to analyze the multiparameter monitoring to see if it is feasible and cost-effective.
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12
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Bai W, Guo H, Ouyang W, Weng Y, Wu C, Liu Y, Zang H, Jacobson L, Xu Y, Lu D, Hu Z, Li S, Arafa HM, Yang Q, Westman AM, MacEwan MR, Rogers JA, Pet MA. Intramuscular Near-Infrared Spectroscopy for Muscle Flap Monitoring in a Porcine Model. J Reconstr Microsurg 2021; 38:321-327. [PMID: 34553344 DOI: 10.1055/s-0041-1732361] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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.
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Affiliation(s)
- Wubin Bai
- Department of Applied Physical Sciences, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Hexia Guo
- Department of Materials Science and Engineering, Querrey Simpson Institute for Bioelectronics, Northwestern University, Chicago, Illinois.,Department of Materials Science and Engineering, Northwestern University, Evanston, Illinois
| | - Wei Ouyang
- Department of Materials Science and Engineering, Querrey Simpson Institute for Bioelectronics, Northwestern University, Chicago, Illinois
| | - Yang Weng
- Department of Materials Science and Engineering, Querrey Simpson Institute for Bioelectronics, Northwestern University, Chicago, Illinois
| | - Changsheng Wu
- Department of Materials Science and Engineering, Querrey Simpson Institute for Bioelectronics, Northwestern University, Chicago, Illinois
| | - Yihan Liu
- Department of Applied Physical Sciences, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Hao Zang
- Department of Materials Science and Engineering, Querrey Simpson Institute for Bioelectronics, Northwestern University, Chicago, Illinois
| | - Lauren Jacobson
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University, St. Louis, Missouri
| | - Yameng Xu
- Department of Mechanical Engineering and Materials Science, Washington University, St. Louis, Missouri
| | - Di Lu
- Department of Materials Science and Engineering, Querrey Simpson Institute for Bioelectronics, Northwestern University, Chicago, Illinois
| | - Ziying Hu
- Department of Materials Science and Engineering, Querrey Simpson Institute for Bioelectronics, Northwestern University, Chicago, Illinois
| | - Shuo Li
- Department of Materials Science and Engineering, Querrey Simpson Institute for Bioelectronics, Northwestern University, Chicago, Illinois
| | - Hany M Arafa
- Department of Materials Science and Engineering, Querrey Simpson Institute for Bioelectronics, Northwestern University, Chicago, Illinois
| | - Quansan Yang
- Department of Materials Science and Engineering, Querrey Simpson Institute for Bioelectronics, Northwestern University, Chicago, Illinois.,Department of Mechanical Engineering, Northwestern University, Evanston, Illinois
| | - Amanda M Westman
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University, St. Louis, Missouri
| | - Matthew R MacEwan
- Department of Neurosurgery, School of Medicine, Washington University, St. Louis, Missouri
| | - John A Rogers
- Department of Materials Science and Engineering, Querrey Simpson Institute for Bioelectronics, Northwestern University, Chicago, Illinois.,Department of Materials Science and Engineering, Northwestern University, Evanston, Illinois.,Department of Mechanical Engineering, Northwestern University, Evanston, Illinois.,Department of Biomedical Engineering, Northwestern University, Evanston, Illinois.,Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Mitchell A Pet
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University, St. Louis, Missouri
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13
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Wu C, Rwei AY, Lee JY, Ouyang W, Jacobson L, Shen H, Luan H, Xu Y, Park JB, Kwak SS, Ni X, Bai W, Franklin D, Li S, Liu Y, Ni X, Westman AM, MacEwan MR, Rogers JA, Pet MA. A Wireless Near-Infrared Spectroscopy Device for Flap Monitoring: Proof of Concept in a Porcine Musculocutaneous Flap Model. J Reconstr Microsurg 2021; 38:96-105. [PMID: 34404105 DOI: 10.1055/s-0041-1732426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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.
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Affiliation(s)
- Changsheng Wu
- Department of Materials Science and Engineering, Querrey Simpson Institute for Bioelectronics, Northwestern University, Chicago, Illinois
| | - Alina Y Rwei
- Department of Materials Science and Engineering, Querrey Simpson Institute for Bioelectronics, Northwestern University, Chicago, Illinois.,Department of Chemical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Jong Yoon Lee
- Department of Materials Science and Engineering, Querrey Simpson Institute for Bioelectronics, Northwestern University, Chicago, Illinois.,Sibel Inc., Evanston, Illinois
| | - Wei Ouyang
- Department of Materials Science and Engineering, Querrey Simpson Institute for Bioelectronics, Northwestern University, Chicago, Illinois
| | - Lauren Jacobson
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University, St. Louis, Missouri
| | - Haixu Shen
- Department of Materials Science and Engineering, Northwestern University, Evanston, Illinois
| | - Haiwen Luan
- Department of Materials Science and Engineering, Querrey Simpson Institute for Bioelectronics, Northwestern University, Chicago, Illinois
| | - Yameng Xu
- Department of Neurosurgery, School of Medicine, Washington University, St. Louis, Missouri
| | | | - Sung Soo Kwak
- Department of Materials Science and Engineering, Querrey Simpson Institute for Bioelectronics, Northwestern University, Chicago, Illinois
| | - Xiaoyue Ni
- Department of Materials Science and Engineering, Querrey Simpson Institute for Bioelectronics, Northwestern University, Chicago, Illinois
| | - Wubin Bai
- Department of Materials Science and Engineering, Northwestern University, Evanston, Illinois
| | - Daniel Franklin
- Department of Materials Science and Engineering, Querrey Simpson Institute for Bioelectronics, Northwestern University, Chicago, Illinois
| | - Shuo Li
- Department of Materials Science and Engineering, Querrey Simpson Institute for Bioelectronics, Northwestern University, Chicago, Illinois
| | - Yiming Liu
- Department of Electrical and Computer Engineering, Northwestern University, Evanston, Illinois
| | - Xinchen Ni
- Department of Materials Science and Engineering, Querrey Simpson Institute for Bioelectronics, Northwestern University, Chicago, Illinois
| | - Amanda M Westman
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University, St. Louis, Missouri
| | - Matthew R MacEwan
- Department of Neurosurgery, School of Medicine, Washington University, St. Louis, Missouri
| | - John A Rogers
- Department of Materials Science and Engineering, Querrey Simpson Institute for Bioelectronics, Northwestern University, Chicago, Illinois.,Department of Materials Science and Engineering, Northwestern University, Evanston, Illinois.,Department of Electrical and Computer Engineering, Northwestern University, Evanston, Illinois.,Department of Mechanical Engineering, Northwestern University, Evanston, Illinois.,Department of Biomedical Engineering, Northwestern University, Evanston, Illinois.,Department of Chemistry, Northwestern University, Evanston, Illinois.,Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Mitchell A Pet
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University, St. Louis, Missouri
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14
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Molitor M, Mestak O, Pink R, Foltan R, Sukop A, Lucchina S. The use of sentinel skin islands for monitoring buried and semi-buried micro-vascular flaps. Part I: Summary and brief description of monitoring methods. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2021; 165:113-130. [PMID: 33821844 DOI: 10.5507/bp.2021.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 02/26/2021] [Indexed: 11/23/2022] Open
Abstract
Micro-vascular flaps have been used for the repair of challenging defects for over 45 years. The risk of failure is reported to be around 5-10% which despite medical and technical advances in recent years remains essentially unchanged. Precise, continuous, sensitive and specific monitoring together with prompt notification of vascular compromise is crucial for the success of the procedure. In this review, we provide a classification and brief description of the reported methods for monitoring the micro-vascular flap and a summary of the benefits over direct visual monitoring. Over 40 different monitoring techniques have been reported but their comparative merits are not always obvious. One looks for early detection of a flap's compromise, improved flap salvage rate and a minimal false-positive or false-negative rate. The cost-effectiveness of any method should also be considered. Direct visualisation of the flap is the method most generally used and still seems to be the simplest, cheapest and most reliable method for flap monitoring. Considering the alternatives, only implantable Doppler ultrasound probes, near infrared spectroscopy and laser Doppler flowmetry have shown any evidence of improved flap salvage rates over direct visual monitoring.
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Affiliation(s)
- Martin Molitor
- Department of Plastic Surgery, First Faculty of Medicine Charles University and Na Bulovce Hospital, Prague, Czech Republic
| | - Ondrej Mestak
- Department of Plastic Surgery, First Faculty of Medicine Charles University and Na Bulovce Hospital, Prague, Czech Republic
| | - Richard Pink
- Department of Maxillofacial Surgery, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Rene Foltan
- Department of Maxillofacial Surgery, General University Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Andrej Sukop
- Department of Plastic Surgery, University Hospital Kralovske Vinohrady and 3rd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Stefano Lucchina
- Hand Unit, General Surgery Department, Locarno's Regional Hospital, Via Ospedale 1, 6600 Locarno, Switzerland
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15
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Molitor M, Mestak O, Pink R, Foltan R, Sukop A, Lucchina S. The use of sentinel skin islands for monitoring buried and semi-buried micro-vascular flaps. Part II: Clinical application. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2021; 165:131-138. [PMID: 33821845 DOI: 10.5507/bp.2021.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/26/2021] [Indexed: 11/23/2022] Open
Abstract
Despite the high success rate of micro-vascular flaps, anastomosis compromise occurs in 5-10% and that can lead to flap failure. Reliable monitoring of the flap is therefore of similar importance to that of the precise surgical procedure itself. Multiple methods have been reported for monitoring of the flap vitality, the first one being direct visual monitoring. In buried flaps direct visualisation is not feasible or is unreliable. In these cases we can extend the buried flap to expose a segment of it to act as a monitoring sentinel. For the purpose of this review we used our clinical experience as a starting point, and for the extended information and expertise we conducted a search of the PubMed database. Over 40 monitoring techniques have been reported to-date. Direct visual monitoring is still generally used method with a reliability of up to 100% and an overall success rate of up to 99%. Direct visualisation remains as the simplest, cheapest and yet a very reliable method of flap monitoring. In this review we provide a description of various possible techniques for externalising part of a buried flap, define the tissues that can be used for this purpose and we summarise the procedures that should be followed to achieve the best reliability and validity of monitoring the skin island.
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Affiliation(s)
- Martin Molitor
- Department of Plastic Surgery, First Faculty of Medicine Charles University and Na Bulovce Hospital, Prague, Czech Republic
| | - Ondrej Mestak
- Department of Plastic Surgery, First Faculty of Medicine Charles University and Na Bulovce Hospital, Prague, Czech Republic
| | - Richard Pink
- Department of Maxillofacial Surgery, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Rene Foltan
- Department of Maxillofacial Surgery, General University Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Andrej Sukop
- Department of Plastic Surgery, University Hospital Kralovske Vinohrady and 3rd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Stefano Lucchina
- Hand Unit, General Surgery Department, Locarno's Regional Hospital, Via Ospedale 1, 6600 Locarno, Switzerland
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16
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Handheld Near-Infrared Fluorescence Imaging Device Using Modified Action Cameras for Peri-Operative Guidance of Microvascular Flap Surgery. J Clin Med 2021; 10:jcm10030410. [PMID: 33494469 PMCID: PMC7865367 DOI: 10.3390/jcm10030410] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/11/2021] [Accepted: 01/18/2021] [Indexed: 11/17/2022] Open
Abstract
Indocyanine green near-infrared fluorescence (ICG-NIRF) imaging has recently come into use as a novel method in peri-operative microvascular flap assessment. However, a majority of the many commercial devices launched for clinical use lack mobility, portability, and cost-efficiency and are thus unsuitable for intra-oral applications. This study introduces a cost-effective, customized, handheld NIRF device following principles of ICG-NIRF imaging. Moreover, the novel characteristics of our prototype, considered in conjunction with a literature review highlighting the significance of fluorescence devices in microvascular surgery, point to a new generation of devices for use in microvascular flap surgery.
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17
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Starr NC, Slade E, Gal TJ, Adekunle A, Bigler D, Cheung B, Wang D, Yeoh M, Liau J, Kejner A. Remote monitoring of head and neck free flaps using near infrared spectroscopic tissue oximetry. Am J Otolaryngol 2021; 42:102834. [PMID: 33229129 DOI: 10.1016/j.amjoto.2020.102834] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 11/04/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Near infrared spectroscopy (NIRS) measures tissue oximetry and perfusion of free tissue transfer with the advantage of remote wireless monitoring for free tissue transfer. It has been widely used in breast and extremity reconstruction but has had limited adoption in the head and neck. MATERIALS AND METHODS A retrospective review of head and neck microvascular reconstruction by three different surgical services over 15 months at one tertiary care hospital was performed. Demographics, flap type, monitoring technique, complications, and flap outcomes were recorded. Monitoring techniques were (1) implantable/handheld Doppler or (2) NIRS. Flap monitoring outcomes were evaluated using multivariate analysis. RESULTS 119 flaps were performed by four surgeons with a success rate of 92% (109/119). Flaps were monitored with Doppler (40%) or NIRS (60%). There was no difference in flap success based on monitoring technique. An ROC analysis identified that the optimal cutoff in immediate StO2 for classifying flap success at discharge was 68%. CONCLUSIONS NIRS was successfully implemented in a high-volume head and neck reconstructive practice. NIRS remote monitoring allowed for flap surveillance without requiring in-hospital presence and was able to identify both arterial and venous compromise.
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18
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Gonzalez J, Gardikiotis I, Ruiz-Moya A, Fontdevila J, Weshahy O, Palacin J, Vinals J, Hong JP. Duplex echography as an adjuvant tool to clinical examination to detect early postoperative free flap vascular compromise. Microsurgery 2020; 41:109-118. [PMID: 33373066 DOI: 10.1002/micr.30699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 10/09/2020] [Accepted: 12/18/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Clinical examination remains the cornerstone for postoperative monitoring of free flaps but is highly dependent on the surgeon's ability and experience. Duplex echography provides a noninvasive objective evaluation of tissue perfusion. The authors hypothesized that duplex echography may be a more sensitive and specific monitoring method for early detection of postoperative flap compromise compared to clinical examination alone. The goal was to evaluate any differences between combined duplex echography and clinical examination flap monitoring versus isolated clinical evaluation. METHODS A total of 730 free flaps in 700 patients were included in the study. We conducted an intra-subject prospective study of a cohort of patients who underwent free flap reconstruction in our unit to compare clinical examination with duplex echography for postoperative monitoring. An inter-subject study was also undertaken comparing the prospective cohort with a historical control group of patients in whom free flap monitoring was made using clinical examination alone. The patency flow and velocities through the artery and vein of the flap were measured at the donor and recipient vessels of every anastomosis by duplex scanning, by the same plastic surgeon every 4 hr, during the first 18 hr after surgery. RESULTS Duplex echography and clinical evaluation were used in 175 patients. The historical cohort included a total of 525 flaps. Every patient with suspicion of vascular compromise based on duplex echography was taken back for surgical re-exploration. There were no cases of overdiagnosis using duplex echography (Sensitivity 100%, Specificity 100%). Clinical evaluation detected issues with the vascularan astomoses in 23/175 flaps. However, it failed to detect 12/22 cases which presented with vascular complications and gave a false indication of possible complications in 13 flaps (Sensitivity 45%, Specificity 92%). CONCLUSION In our practice, duplex echography is considered a useful adjunct monitoring tool for early detection of postoperative flap compromise, which compliments clinical evaluation. It provides anatomic and hemodynamic information of the vascular status and may therefore increase survival of flaps by allowing earlier detection of vascular compromise, compared to clinical examination alone, in postoperative monitoring of free flaps.
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Affiliation(s)
- Jesus Gonzalez
- Department of Plastic Surgery, Hospital de la Santa Creu i Sant Pau, Clinic Barcelona Hospital University, Spain
| | - Ioannis Gardikiotis
- Department of Plastic Surgery, Grigore T. Popa University of Medicine and Pharmacy of Iasi, CEMEX, Sf. Maria Children's Emergency Hospital, Lasi, Romania
| | | | - Joan Fontdevila
- Department of Plastic Surgery, Clinic Barcelona Hospital University, Barcelona, Spain
| | - Omar Weshahy
- Department of Plastic Surgery, Clinic Barcelona Hospital University, Barcelona, Spain
| | - Jose Palacin
- Department of Plastic Surgery, Bellvitge University Hospital, Barcelona, Spain
| | - Joan Vinals
- Department of Plastic Surgery, Bellvitge University Hospital, Barcelona, Spain
| | - Joon Pio Hong
- Department of Plastic Surgery, Asan Medical Center, Seoul, South Korea
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19
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Wallner C, Kolbenschlag J, Daigeler A, Stambera P, Andree C, Rieger UM, Behr B, Schaefer DJ, Kneser U, Lehnhardt M. Perioperatives Management in der Mikrochirurgie – Konsensus-Statement der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie der peripheren Nerven und Gefäße. HANDCHIR MIKROCHIR P 2020; 52:310-315. [PMID: 32823366 DOI: 10.1055/a-1205-1309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Perioperative management in microsurgery is a key element of success in reconstructive surgery. There are no uniform concepts for this in the German-speaking countries and individual schemes differ significantly from each other, as ascertained in an expert survey. In the course of the 41st Annual Conference of the German-speaking Working Group for Microsurgery (DAM) held in Munich in November 2019, concepts were evaluated and a survey was carried out and summarised as a position paper in due consideration of the scientific literature.
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Affiliation(s)
- Christoph Wallner
- Universitätsklinik für Plastische Chirurgie und Handchirurgie, Schwerbrandverletztenzentrum, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil
| | - Jonas Kolbenschlag
- Universitätsklinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie, BG Klinik Tübingen
| | - Adrien Daigeler
- Universitätsklinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie, BG Klinik Tübingen
| | - Peter Stambera
- Klinik für Plastische und Ästhetische Chirurgie, Sana-Kliniken Düsseldorf, Krankenhaus Gerresheim, Akademisches Lehrkrankenhaus der Heinrich Heine Universität Düsseldorf
| | - Christoph Andree
- Klinik für Plastische und Ästhetische Chirurgie, Sana-Kliniken Düsseldorf, Krankenhaus Gerresheim, Akademisches Lehrkrankenhaus der Heinrich Heine Universität Düsseldorf
| | - Ulrich Michael Rieger
- Klinik & Praxis für Plastische und Ästhetische Chirurgie, Wiederherstellungs- und Handchirurgie, Agaplesion Markus Krankenhaus
| | - Björn Behr
- Universitätsklinik für Plastische Chirurgie und Handchirurgie, Schwerbrandverletztenzentrum, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil
| | - Dirk Johannes Schaefer
- Universitätsklinik für Plastische, Rekonstruktive, Ästhetische und Handchirurgie, Universitätsspital Basel
| | - Ulrich Kneser
- Klinik für Hand-, Plastische und Rekonstruktive Chirurgie, Mikrochirurgie, Schwerbrandverletztenzentrum, BG-Klinik Ludwigshafen, Klinik für Plastische und Handchirurgie an der Universität Heidelberg
| | - Marcus Lehnhardt
- Universitätsklinik für Plastische Chirurgie und Handchirurgie, Schwerbrandverletztenzentrum, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil
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20
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Molnar A, Magyar Z, Nachmias DB, Mann D, Szabo B, Toth L, Nemeth N. Effect of short-term ischemia on microcirculation and wound healing of adipocutaneous flaps in the rat. Acta Cir Bras 2020; 34:e201901203. [PMID: 32049184 PMCID: PMC7011208 DOI: 10.1590/s0102-865020190120000003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/18/2019] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Composite flaps used in reconstructive surgery may intra- and postoperatively suffer from hypoperfusion and/or ischemia-reperfusion influencing wound healing. We aimed to follow-up the effect of ischemia on adipocutaneous flaps' wound healing and microcirculation. METHODS In anesthetized rats groin flaps were formed bilaterally. In Control group the flaps were repositioned and sutured back. In Ischemia-Reperfusion (I/R) group before repositioning and suturing the flap pedicles were clamped for 60 minutes. Laser Doppler (LD) fluxmetry and temperature probes were applied on the cranial, central and caudal flap regions before/after preparation and ischemia, re-suturing, and on the 1st-3rd-5th-7th-14th postoperative days, before the final examinations and biopsies for histology. RESULTS Flaps' skin temperature quickly recovered after repositioning. LD values were lower in the I/R group, reaching a significant level by the 3rd postoperative day, and remained lowered till the 14th day. The magnitude of alterations differed in the flap regions. Histologically normal wound healing process was seen, except for some I/R flaps, where hypertrophized mammary glands were found. CONCLUSIONS Short-term ischemia could influence flap microcirculation and wound healing, and may result in hypertrophized mammary glands. Laser Doppler could be used to evaluate intra- and postoperative microcirculatory changes and may have significance in predicting complications.
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21
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Newton E, Butskiy O, Shadgan B, Prisman E, Anderson DW. Outcomes of free flap reconstructions with near‐infrared spectroscopy (NIRS) monitoring: A systematic review. Microsurgery 2020; 40:268-275. [DOI: 10.1002/micr.30526] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 07/01/2019] [Accepted: 10/04/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Ethan Newton
- Division of Otolaryngology—Head & Neck SurgeryUniversity of British Columbia Vancouver British Columbia Canada
| | - Oleksandr Butskiy
- Division of Otolaryngology—Head & Neck SurgeryUniversity of British Columbia Vancouver British Columbia Canada
| | - Babak Shadgan
- Department of OrthopaedicsUniversity of British Columbia Vancouver British Columbia Canada
- International Collaboration on Repair Discoveries Vancouver British Columbia Canada
| | - Eitan Prisman
- Division of Otolaryngology—Head & Neck SurgeryUniversity of British Columbia Vancouver British Columbia Canada
| | - Donald W. Anderson
- Division of Otolaryngology—Head & Neck SurgeryUniversity of British Columbia Vancouver British Columbia Canada
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22
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Berthelot M, Ashcroft J, Boshier P, Hunter J, Henry FP, Lo B, Yang GZ, Leff D. Use of Near-infrared Spectroscopy and Implantable Doppler for Postoperative Monitoring of Free Tissue Transfer for Breast Reconstruction: A Systematic Review and Meta-analysis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2437. [PMID: 31772881 PMCID: PMC6846307 DOI: 10.1097/gox.0000000000002437] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 07/12/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Failure to accurately assess the perfusion of free tissue transfer (FTT) in the early postoperative period may contribute to failure, which is a source of major patient morbidity and healthcare costs. This systematic review and meta-analysis aim to evaluate and appraise current evidence for the use of near-infrared spectroscopy (NIRS) and/or implantable Doppler (ID) devices compared with conventional clinical assessment (CCA) for postoperative monitoring of FTT in reconstructive breast surgery. METHODS A systematic literature search was performed in accordance with the preferred reporting items for systematic reviews guidelines. Studies in human subjects published within the last decade relevant to the review question were identified. Meta-analysis using random-effects models of FTT failure rate and STARD scoring was then performed on the retrieved publications. RESULTS Nineteen studies met the inclusions criteria. For NIRS and ID, the mean sensitivity for the detection of FTT failure is 99.36% and 100% respectively, with average specificity of 99.36% and 97.63%, respectively. From studies with sufficient reported data, meta-analysis results demonstrated that both NIRS [OR = 0.09 (0.02-0.36); P < 0.001] and ID [OR = 0.39 (0.27-0.95); P = 0.04] were associated with significant reduction of FTT failure rates compared with CCA. CONCLUSIONS The use of ID and NIRS provided equivalent outcomes in detecting FTT failure and were superior to CCA. The ability to acquire continuous objective physiological data regarding tissue perfusion is a perceived advantage of these techniques. Reduced clinical staff workload and minimized hospital costs are also perceived as positive consequences of their use.
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Affiliation(s)
- Melissa Berthelot
- From the The Hamlyn Centre for Robotic Surgery, Imperial College London, United Kingdom
| | - James Ashcroft
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Piers Boshier
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Judith Hunter
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | | | - Benny Lo
- From the The Hamlyn Centre for Robotic Surgery, Imperial College London, United Kingdom
| | - Guang-Zhong Yang
- From the The Hamlyn Centre for Robotic Surgery, Imperial College London, United Kingdom
| | - Daniel Leff
- From the The Hamlyn Centre for Robotic Surgery, Imperial College London, United Kingdom
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Berthelot M, Henry FP, Hunter J, Leff D, Wood S, Jallali N, Dex E, Lysakova L, Lo B, Yang GZ. Pervasive wearable device for free tissue transfer monitoring based on advanced data analysis: clinical study report. JOURNAL OF BIOMEDICAL OPTICS 2019; 24:1-8. [PMID: 31218875 PMCID: PMC6977400 DOI: 10.1117/1.jbo.24.6.067001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 05/16/2019] [Indexed: 06/09/2023]
Abstract
Free tissue transfer (FTT) surgery for breast reconstruction following mastectomy has become a routine operation with high success rates. Although failure is low, it can have a devastating impact on patient recovery, prognosis, and psychological well-being. Continuous and objective monitoring of tissue oxygen saturation (StO2) has been shown to reduce failure rates through rapid detection time of postoperative vascular complications. We have developed a pervasive wearable wireless device that employs near-infrared spectroscopy (NIRS) to continuously monitor FTT via StO2 measurement. Previously tested on different models, the results of a clinical study are introduced. Our goal for the study is to demonstrate that the developed device can reliably detect StO2 variations in a clinical setting: 14 patients were recruited. Advanced data analysis was performed on the StO2 variations, the relative StO2 gradient change, and the classification of the StO2 within different clusters of blood occlusion level (from 0% to 100% at 25% step) based on previous studies made on a vascular phantom and animals. The outcomes of the clinical study concur with previous experimental results and the expected biological responses. This suggests that the device is able to correctly detect perfusion changes and provide real-time assessment on the viability of the FTT in a clinical setting.
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Affiliation(s)
- Melissa Berthelot
- Imperial College London, The Hamlyn Centre, South Kensington Campus, London, United Kingdom
| | - Francis Patrick Henry
- Imperial College Healthcare NHS Trust London, Charing Cross Hospital, London, United Kingdom
| | - Judith Hunter
- Imperial College Healthcare NHS Trust London, Charing Cross Hospital, London, United Kingdom
| | - Daniel Leff
- Imperial College Healthcare NHS Trust London, Charing Cross Hospital, London, United Kingdom
| | - Simon Wood
- Imperial College Healthcare NHS Trust London, Charing Cross Hospital, London, United Kingdom
| | - Navid Jallali
- Imperial College Healthcare NHS Trust London, Charing Cross Hospital, London, United Kingdom
| | - Elizabeth Dex
- Imperial College Healthcare NHS Trust London, Charing Cross Hospital, London, United Kingdom
| | - Ladislava Lysakova
- Imperial College Healthcare NHS Trust London, Charing Cross Hospital, London, United Kingdom
| | - Benny Lo
- Imperial College London, The Hamlyn Centre, South Kensington Campus, London, United Kingdom
| | - Guang-Zhong Yang
- Imperial College London, The Hamlyn Centre, South Kensington Campus, London, United Kingdom
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24
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Kohlert S, Quimby AE, Saman M, Ducic Y. Postoperative Free-Flap Monitoring Techniques. Semin Plast Surg 2019; 33:13-16. [PMID: 30863207 DOI: 10.1055/s-0039-1677880] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Free tissue transfer is commonly employed in the reconstruction of large or complicated defects. Postoperative flap failure from microvascular compromise is an uncommon but major potential complication of this procedure. As such, many postoperative monitoring techniques devices have been developed. This paper provides an overview of the wide variety of options available for surgeons today.
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Affiliation(s)
- Scott Kohlert
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Alexandra E Quimby
- Department of Otolaryngology - Head and Neck Surgery, University of Ottawa, Ottawa, Canada
| | - Masoud Saman
- Saman Center for Facial Plastic Surgery, Plano, Texas
| | - Yadranko Ducic
- Department of Facial Plastic and Reconstructive Surgery, Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
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25
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Park SO, Son Y, Kim IK, Jin US, Chang H. Effectiveness of small monitoring skin paddle in free muscle flap for scalp reconstruction. Head Neck 2018; 40:2399-2408. [PMID: 30175898 DOI: 10.1002/hed.25347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 02/12/2018] [Accepted: 05/08/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Monitoring free muscle flaps with skin grafts is difficult. To intensify the monitoring process for this type of flap, a small skin paddle was included in the flap and analyzed its effects. METHODS A retrospective analysis of all patients who underwent scalp reconstruction with a free latissimus dorsi flap and skin graft between 1994 and 2016 was conducted. Flap monitoring was proceeded using a combination of clinical examination and handheld Doppler for both types of flaps. RESULTS A total of 71 patients were included in this study and were divided into a study group (skin paddle included; n = 30) and a control group (conventional method; n = 41). The time between initial surgery to pedicle exploration was significantly shorter in the study group (11.3 ± 2.5 vs 79.8 ± 42.6 hours; P = .024). The flap salvage rate was significantly higher in the study group (100% vs 16.7%; P = .048). CONCLUSION The efficacy of flap monitoring and flap salvage outcomes were improved by including a small monitoring skin flap.
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Affiliation(s)
- Seong Oh Park
- Department of Plastic and Reconstructive Surgery, Research Institute of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Yoosung Son
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Il-Kug Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Ung Sik Jin
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hak Chang
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Korea
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26
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Liu S, Zhang WB, Yu Y, Wang Y, Mao C, Guo CB, Yu GY, Peng X. Free Flap Transfer for Pediatric Head and Neck Reconstruction: What Factors Influence Flap Survival? Laryngoscope 2018; 129:1915-1921. [PMID: 30152141 DOI: 10.1002/lary.27442] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 05/25/2018] [Accepted: 06/22/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Shuo Liu
- Department of Oral and Maxillofacial Surgery; Peking University School and Hospital of Stomatology; Beijing People's Republic of China
| | - Wen-bo Zhang
- Department of Oral and Maxillofacial Surgery; Peking University School and Hospital of Stomatology; Beijing People's Republic of China
| | - Yao Yu
- Department of Oral and Maxillofacial Surgery; Peking University School and Hospital of Stomatology; Beijing People's Republic of China
| | - Yang Wang
- Department of Oral and Maxillofacial Surgery; Peking University School and Hospital of Stomatology; Beijing People's Republic of China
| | - Chi Mao
- Department of Oral and Maxillofacial Surgery; Peking University School and Hospital of Stomatology; Beijing People's Republic of China
| | - Chuan-bin Guo
- Department of Oral and Maxillofacial Surgery; Peking University School and Hospital of Stomatology; Beijing People's Republic of China
| | - Guang-yan Yu
- Department of Oral and Maxillofacial Surgery; Peking University School and Hospital of Stomatology; Beijing People's Republic of China
| | - Xin Peng
- Department of Oral and Maxillofacial Surgery; Peking University School and Hospital of Stomatology; Beijing People's Republic of China
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27
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Smit JM, Negenborn VL, Jansen SM, Jaspers MEH, de Vries R, Heymans MW, Winters HAH, van Leeuwen TG, Mullender MG, Krekel NMA. Intraoperative evaluation of perfusion in free flap surgery: A systematic review and meta-analysis. Microsurgery 2018; 38:804-818. [DOI: 10.1002/micr.30320] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 02/03/2018] [Accepted: 03/02/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Jan Maerten Smit
- Department of Plastic, Reconstructive & Hand Surgery; VU University Medical Centre; Amsterdam The Netherlands
| | - Vera L. Negenborn
- Department of Plastic, Reconstructive & Hand Surgery; VU University Medical Centre; Amsterdam The Netherlands
- Amsterdam Public Health research institute; VU University Medical Center; Amsterdam The Netherlands
| | - Sanne M. Jansen
- Department of Plastic, Reconstructive & Hand Surgery; Academical Medical Center; Amsterdam The Netherlands
| | - Mariëlle E. H. Jaspers
- Department of Plastic, Reconstructive & Hand Surgery; VU University Medical Centre; Amsterdam The Netherlands
- Association of Dutch Burn Centers; Beverwijk The Netherlands
| | - Ralph de Vries
- Medical Library, Vrije Universiteit; Amsterdam The Netherlands
| | - Martijn W. Heymans
- Department of Epidemiology & Biostatistics; VU University Medical Centre; Amsterdam The Netherlands
| | - Hay A. H. Winters
- Department of Plastic, Reconstructive & Hand Surgery; VU University Medical Centre; Amsterdam The Netherlands
| | - Ton G. van Leeuwen
- Department of. Biomedical Engineering & Physics; Academical Medical Center; Amsterdam The Netherlands
| | - Margriet G. Mullender
- Department of Plastic, Reconstructive & Hand Surgery; VU University Medical Centre; Amsterdam The Netherlands
- Amsterdam Movement Sciences; VU University Medical Center; Amsterdam The Netherlands
| | - Nicole M. A. Krekel
- Department of Plastic, Reconstructive & Hand Surgery; VU University Medical Centre; Amsterdam The Netherlands
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28
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Lee SY, Pakela JM, Helton MC, Vishwanath K, Chung YG, Kolodziejski NJ, Stapels CJ, McAdams DR, Fernandez DE, Christian JF, O’Reilly J, Farkas D, Ward BB, Feinberg SE, Mycek MA. Compact dual-mode diffuse optical system for blood perfusion monitoring in a porcine model of microvascular tissue flaps. JOURNAL OF BIOMEDICAL OPTICS 2017; 22:1-14. [PMID: 29243415 PMCID: PMC5729962 DOI: 10.1117/1.jbo.22.12.121609] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 11/06/2017] [Indexed: 05/25/2023]
Abstract
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.
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Affiliation(s)
- Seung Yup Lee
- University of Michigan, Department of Biomedical Engineering, Ann Arbor, Michigan, United States
| | - Julia M. Pakela
- University of Michigan, Applied Physics Program, Ann Arbor, Michigan, United States
| | - Michael C. Helton
- University of Michigan, Department of Biomedical Engineering, Ann Arbor, Michigan, United States
- University of Michigan, Applied Physics Program, Ann Arbor, Michigan, United States
| | | | - Yooree G. Chung
- University of Michigan, Department of Biomedical Engineering, Ann Arbor, Michigan, United States
| | | | | | - Daniel R. McAdams
- Radiation Monitoring Devices Inc., Watertown, Massachusetts, United States
| | | | - James F. Christian
- Radiation Monitoring Devices Inc., Watertown, Massachusetts, United States
| | - Jameson O’Reilly
- Radiation Monitoring Devices Inc., Watertown, Massachusetts, United States
- Northeastern University, Boston, Massachusetts, United States
| | - Dana Farkas
- Radiation Monitoring Devices Inc., Watertown, Massachusetts, United States
- Northeastern University, Boston, Massachusetts, United States
| | - Brent B. Ward
- University of Michigan, Department of Oral and Maxillofacial Surgery, Ann Arbor, Michigan, United States
| | - Stephen E. Feinberg
- University of Michigan, Department of Oral and Maxillofacial Surgery, Ann Arbor, Michigan, United States
| | - Mary-Ann Mycek
- University of Michigan, Department of Biomedical Engineering, Ann Arbor, Michigan, United States
- University of Michigan, Applied Physics Program, Ann Arbor, Michigan, United States
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29
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Current Techniques for Postoperative Monitoring of Microvascular Free Flaps. J Wound Ostomy Continence Nurs 2017; 44:148-152. [PMID: 28267121 DOI: 10.1097/won.0000000000000314] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Free tissue transfer (FTT) is used in patients with complicated reconstructive needs; it can provide stable wound coverage, improved aesthetic appearance, and restore functional deficits. Despite the high success rates of free flaps, vascular occlusion is a significant risk leading to flap failure. Many studies have demonstrated that the salvage rate for flaps is inversely related to the time between onset of a vascular problem and its surgical correction. As a result, ongoing postoperative monitoring of free flaps for adequate perfusion is imperative to allow timely and accurate diagnosis of vascular compromise. Close monitoring and prompt notification of the physician if vascular compromise occurs are typically undertaken by first-line nurses. We conducted an integrative literature to identify and evaluate commonly used techniques for monitoring vascular free flaps during the postoperative period. We searched PubMed and Science Direct electronic databases, using the key words: "free-flap" and "monitoring." This article discusses commonly monitoring modalities, along with their advantages and limitations. Whereas large academic institutions may have an experienced nursing staff specifically trained in effective methods for monitoring free flap patients, this situation may not exist in all hospitals where free flap surgeries are performed. We describe techniques that allow easy and timely detection of flap compromise by nursing staff while reducing interuser variability.
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30
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Safonova TN, Kintyukhina NP, Sidorov VV, Gladkova OV, Reyn ES. [Microcirculatory blood and lymph flow examination in eyelid skin by laser Doppler flowmetry]. Vestn Oftalmol 2017; 133:16-21. [PMID: 28745652 DOI: 10.17116/oftalma2017133316-21] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
AIM to study normal blood and lymph microcirculation of the upper and lower eyelids in different age groups. MATERIAL AND METHODS The study included 108 volunteers (216 eyes) aged from 20 to 80 years with no signs of changes in anterior segment structures, who were grouped by age ranges (20-30 years, 31-40 years, 41-50 years, 51-60 years, 61-70 years, and 71-80 years) into 6 groups equal in gender and quantitative composition. In all volunteers, microcirculation of the upper and lower eyelids was examined by laser Doppler flowmetry (LDF) ('LASMA MC-1' peripheral blood and lymph flow analyzer and 'LASMA MC' laser diagnostic complex, LASMA LLC). The average perfusion changes in blood and lymph flow as well as blood and lymph flow oscillations were analyzed. RESULTS Blood and lymph flow in the microvasculature of the upper and lower eyelids is variable and depends on neither the age, nor gender of the test subject. On LDF-gram, every increase in amplitude of blood flow corresponds to a decrease in that of lymph flow. CONCLUSION The non-invasive method of LDF expands our diagnostic capabilities as it enables assessment of not only blood, but also lymph flow. The data obtained can serve as a starting point for exploring microcirculation in different age groups in the presence of different pathological processes.
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Affiliation(s)
- T N Safonova
- Research Institute of Eye Diseases 11 A, B Rossolimo St., Moscow, Russia, 119021
| | - N P Kintyukhina
- Research Institute of Eye Diseases 11 A, B Rossolimo St., Moscow, Russia, 119021
| | - V V Sidorov
- LASMA LLC, 8 Tvardovskogo St., Moscow, Russia, 123458
| | - O V Gladkova
- Research Institute of Eye Diseases 11 A, B Rossolimo St., Moscow, Russia, 119021
| | - E S Reyn
- Research Institute of Eye Diseases 11 A, B Rossolimo St., Moscow, Russia, 119021
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31
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Safonova TN, Lutsevich EE, Kintukhina NP. [Icrocirculatory changes I bulbar conjunctiva in various diseases]. Vestn Oftalmol 2016; 132:90-95. [PMID: 27347572 DOI: 10.17116/oftalma2016132290-95] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The article presents a literature review of the latest achievements in visualizing microcirculation and studying anatomical and physiological characteristics of microcirculation in the bulbar conjunctiva in various diseases.
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Affiliation(s)
- T N Safonova
- Research Institute of Eye Diseases, 11 A, B, Rossolimo St., Moscow, Russian Federation, 119021
| | - E E Lutsevich
- Research Institute of Eye Diseases, 11 A, B, Rossolimo St., Moscow, Russian Federation, 119021
| | - N P Kintukhina
- Research Institute of Eye Diseases, 11 A, B, Rossolimo St., Moscow, Russian Federation, 119021
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32
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Abstract
Postoperative monitoring of free flaps remains an essential component of care in patients undergoing microsurgical reconstructive surgery. Early recognition of vascular problems and prompt surgical intervention improve the chances for flap salvage. Physical examination remains the cornerstone of free flap monitoring, but more recently, additional technologies have been developed for this purpose. In this article, current approaches to free flap monitoring are reviewed.
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