Continuous intraoperative perfusion monitoring of free microvascular anastomosed fasciocutaneous flaps using remote photoplethysmography

Schraven, Sebastian P.; Kossack, Benjamin; Strüder, Daniel; Jung, Maximillian; Skopnik, Lotte; Groß, Justus; Hilsmann, Anna; Eisert, Peter; Mlynski, Robert; Wisotzky, Eric L.

doi:10.1038/s41598-023-28277-w

Cited by 12 publications

(9 citation statements)

References 70 publications

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“…Best medical care needs preoperative planning and peri‐ and postoperative assessment of flap perfusion. A key to successful reconstructive surgery is the necessity for preoperative planning and intra‐ and postoperative assessment of flap perfusion to limit necrosis or flap loss [4]. Preoperative flap planning has evolved in recent times.…”

Section: Introductionmentioning

confidence: 99%

An overview of current assessment techniques for evaluating cutaneous perfusion in reconstructive surgery

Fiedler,

Daaloul

2024

Journal of Biophotonics

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This article provides a comprehensive analysis of modern techniques used in the assessment of cutaneous flaps in reconstructive surgery. It emphasizes the importance of preoperative planning and intra‐ and perioperative assessment of flap perfusion to ensure successful outcomes. Despite technological advancements, direct clinical assessment remains the gold standard. We categorized assessment techniques into non‐invasive and invasive modalities, discussing their strengths and weaknesses. Non‐invasive methods, such as acoustic Doppler sonography, near‐infrared spectroscopy, hyperspectral imaging thermal imaging, and remote‐photoplethysmography, offer accessibility and safety but may sacrifice specificity. Invasive techniques, including contrast‐enhanced ultrasound, computed tomography angiography, near‐infrared fluorescence angiography with indocyanine green, and implantable Doppler probe, provide high accuracy but introduce additional risks. We emphasize the need for a tailored decision‐making process based on specific clinical scenarios, patient characteristics, procedural requirements, and surgeon expertise. It also discusses potential future advancements in flap assessment, including the integration of artificial intelligence and emerging technologies.

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Section: Introductionmentioning

confidence: 99%

An overview of current assessment techniques for evaluating cutaneous perfusion in reconstructive surgery

Fiedler,

Daaloul

2024

Journal of Biophotonics

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“…A key to successful reconstructive surgery is the necessity for preoperative planning and intra-and postoperative assessment of flap perfusion to limit necrosis or flap loss. [4] Preoperative flap planning has evolved in recent times. In the past, flap planning was based on surgical and anatomical landmarks and flap proportions.…”

Section: Introductionmentioning

confidence: 99%

An overview of current assessment techniques for evaluating cutaneous perfusion in reconstructive surgery

Fiedler,

Daaloul

2024

Preprint

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This paper provides a comprehensive analysis of modern techniques used in the assessment of cutaneous flaps in reconstructive surgery. It emphasizes the importance of preoperative planning and intra- and perioperative assessment of flap perfusion to ensure successful outcomes. Despite technological advancements, direct clinical assessment remains the gold standard. We categorized assessment techniques into non-invasive and invasive modalities, discussing their strengths and weaknesses. Non-invasive methods, such as Acoustic Doppler Sonography, Near-Infrared Spectroscopy, Hyperspectral Imaging Thermal Imaging, and remote-Photoplethysmography, offer accessibility and safety but may sacrifice specificity. Invasive techniques, including Contrast-Enhanced Ultrasound, Computed Tomography Angiography, Near-Infrared Fluorescence Angiography with Indocyanine Green, and Implantable Doppler Probe, provide high accuracy but introduce additional risks. We emphasize the need for a tailored decision-making process based on specific clinical scenarios, patient characteristics, procedural requirements, and surgeon expertise. It also discusses potential future advancements in flap assessment, including the integration of artificial intelligence and emerging technologies.

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“…Remote photoplethysmography (rPPG) also provides information on tissue perfusion by time-dependent imaging of remitted light with a contactless optical sensor 16 – 20 . The intensity of the remitted light depends on the number of red blood cells and the pulsatile movement of arterial and venous blood within the imaged tissue area 17 .…”

Section: Introductionmentioning

confidence: 99%

“…The intensity of the remitted light depends on the number of red blood cells and the pulsatile movement of arterial and venous blood within the imaged tissue area 17 . The remitted light is usually recorded by a camera as a sequence of RGB images 16 , 17 , 19 . The time-dependent rPPG signals are calculated from the resulting RGB images, and spatially resolved perfusion signal results can be directly visualized intraoperatively during surgery 16 , 17 , 19 , 20 .…”

Section: Introductionmentioning

confidence: 99%

Investigation on the influence of the skin tone on hyperspectral imaging for free flap surgery

Pachyn,

Aumiller,

Freymüller

et al. 2024

Sci Rep

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Hyperspectral imaging (HSI) is a new emerging modality useful for the noncontact assessment of free flap perfusion. This measurement technique relies on the optical properties within the tissue. Since the optical properties of hemoglobin (Hb) and melanin overlap, the results of the perfusion assessment and other tissue-specific parameters are likely to be distorted by the melanin, especially at higher melanin concentrations. Many spectroscopic devices have been shown to struggle with a melanin related bias, which results in a clinical need to improve non-invasive perfusion assessment, especially for a more pigmented population. This study investigated the influence of skin tones on tissue indices measurements using HSI. In addition, other factors that might affect HSI, such as age, body mass index (BMI), sex or smoking habits, were also considered. Therefore, a prospective feasibility study was conducted, including 101 volunteers from whom tissue indices measurements were performed on 16 different body sites. Skin tone classification was performed using the Fitzpatrick skin type classification questionnaire, and the individual typology angle (ITA) acquired from the RGB images was calculated simultaneously with the measurements. Tissue indices provided by the used HSI-device were correlated to the possible influencing factors. The results show that a dark skin tone and, therefore, higher levels of pigmentation influence the HSI-derived tissue indices. In addition, possible physiological factors influencing the HSI-measurements were found. In conclusion, the HSI-based tissue indices can be used for perfusion assessment for people with lighter skin tone levels but show limitations in people with darker skin tones. Furthermore, it could be used for a more individual perfusion assessment if different physiological influencing factors are respected.

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Continuous intraoperative perfusion monitoring of free microvascular anastomosed fasciocutaneous flaps using remote photoplethysmography

Cited by 12 publications

References 70 publications

An overview of current assessment techniques for evaluating cutaneous perfusion in reconstructive surgery

An overview of current assessment techniques for evaluating cutaneous perfusion in reconstructive surgery

An overview of current assessment techniques for evaluating cutaneous perfusion in reconstructive surgery

Investigation on the influence of the skin tone on hyperspectral imaging for free flap surgery

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