Continuous postoperative monitoring of cutaneous free flaps using near infrared spectroscopy

Repež, Andrej; Oroszy, D.; Arnež, Zoran Marij

doi:10.1016/j.bjps.2007.04.003

Cited by 136 publications

(136 citation statements)

References 33 publications

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“…[14][15][16] Devices intended to replace clinical assessment need to meet several criteria in order to be appropriate for routine use. Among other parameters, devices should be highly reliable, simple to operate, and easy to interpret.…”

Section: Discussionmentioning

confidence: 99%

A critical evaluation of the concomitant use of the implantable Doppler probe and the Vacuum Assisted Closure system in free tissue transfer

et al. 2008

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Introduction of the Vacuum-Assisted Closure (V.A.C.) system has revolutionized the approach to a multitude of clinical settings. Yet, its use precludes adequate clinical monitoring of skin-grafted free flaps, thus, making a reliable monitoring system essential if broad clinical application is aspired. In a clinical study, the usefulness of the combination of the V.A.C. and implantable Doppler probe was critically evaluated in patients with microsurgical lower extremity reconstruction. We retrospectively analyzed the usefulness of the implantable Doppler probe in five consecutive patients treated in our department from January to July 2007. Inclusion criteria were lower extremity reconstruction by means of skin-grafted free tissue transfers with subsequent application of the V.A.C. device. Five consecutive patients (four males, one female) with a mean age of 37.8 years (range, 8-58 years) matched the criteria mentioned above. Of note, the two pediatric patients (8-year-old male and 12-year-old female) suffered from significant posttraumatic stress disorder necessitating concomitant psychological care by the Department of Psychiatry. All flaps healed uneventfully displaying no signs of vascular compromise. Interpretation of the Doppler signal was simple and well received by the nursing staff. The combination of V.A.C. and the implantable Doppler probe enhances patient comfort due to a reduction of the number of dressing changes while still allowing continuous free flap monitoring. Interpretation of the signal transmitted by the probe is simple and potentially reduces misinterpretations due to different levels of experience.

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Section: Discussionmentioning

confidence: 99%

A critical evaluation of the concomitant use of the implantable Doppler probe and the Vacuum Assisted Closure system in free tissue transfer

et al. 2008

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“…Thus, surface measurement is preferable. Surface DRS probes have been used in several settings [12,35], but never in measurements of human internal organs. In this study, noninvasive DRS measurements with a surface probe on resected liver specimens originating from 18 patients were made.…”

Section: Discussionmentioning

confidence: 99%

“…Diffuse reflectance spectroscopy (DRS) is an optical measuring method that is fast, convenient, and relatively established, and is used in different areas such as the lung, breast, skin, and gut [9,10,11,12,13]. Tissue is illuminated with light from a broadband light source, and after interacting with the tissue, the diffusely reflected light is collected and analyzed.…”

Section: Introductionmentioning

confidence: 99%

Diffuse Reflectance Spectroscopy for Surface Measurement of Liver Pathology

et al. 2016

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Background: Liver parenchymal injuries such as steatosis, steatohepatitis, fibrosis, and sinusoidal obstruction syndrome can lead to increased morbidity and liver failure after liver resection. Diffuse reflectance spectroscopy (DRS) is an optical measuring method that is fast, convenient, and established. DRS has previously been used on the liver with an invasive technique consisting of a needle that is inserted into the parenchyma. We developed a DRS system with a hand-held probe that is applied to the liver surface. In this study, we investigated the impact of the liver capsule on DRS measurements and whether liver surface measurements are representative of the whole liver. We also wanted to confirm that we could discriminate between tumor and liver parenchyma by DRS. Materials and Methods: The instrumentation setup consisted of a light source, a fiber-optic contact probe, and two spectrometers connected to a computer. Patients scheduled for liver resection due to hepatic malignancy were included, and DRS measurements were performed on the excised liver part with and without the liver capsule and alongside a newly cut surface. To estimate the scattering parameters and tissue chromophore volume fractions, including blood, bile, and fat, the measured diffuse reflectance spectra were applied to an analytical model. Results: In total, 960 DRS spectra from the excised liver tissue of 18 patients were analyzed. All factors analyzed regarding tumor versus liver tissue were significantly different. When measuring through the capsule, the blood volume fraction was found to be 8.4 ± 3.5%, the lipid volume fraction was 9.9 ± 4.7%, and the bile volume fraction was 8.2 ± 4.6%. No differences could be found between surface measurements and cross-sectional measurements. In measurements with/without the liver capsule, the differences in volume fraction were 1.63% (0.75-2.77), -0.54% (-2.97 to 0.32), and -0.15% (-1.06 to 1.24) for blood, lipid, and bile, respectively. Conclusion: This study shows that it is possible to manage DRS measurements through the liver capsule and that surface DRS measurements are representative of the whole liver. The results are consistent with data published earlier on the combination of liver chromophores. The results encourage us to proceed with in vivo measurements for further quantification of the liver's composition and assessment of parenchymal damage such as steatosis and fibrosis grade.

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“…Visual inspection is a widely used monitoring method, but it is not objective. To date, many kinds of monitoring techniques for the detection of post-operative flap ischemia have been developed [3]. Such methods include photoplethysmography, electrical impedance plethysmography, intravenous fluorescein test, assessment of muscle contraction, surface temperature monitoring, transcutaneous oxygen/carbon dioxide tension monitoring, Doppler ultrasonography, etc.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Flap Tissue Viability by F-18 FDG PET/CT

Lee

Kang

Heo

et al. 2014

Nucl Med Mol Imaging

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A 60-year-old man underwent vertical rectus abdominis myocutaneous flap to reconstruct a left lateral chest wall defect. For assessment of viability of muscle flap, F-18 fluoro-2-deoxyglucose (FDG) positron emission tomography/ computed tomography (PET/CT) was performed 15 days after surgery. The FDG PET/CT showed a small metabolic defect in the left lateral chest wall. During follow-up, necrotic change of the graft was observed, and the site was in accordance with the area where the metabolic defect was observed in the FDG PET/CT. As a result, debridement and wound closure was performed. This case suggested that the FDG PET/CT should be a useful method for the monitoring of muscle viability after flap surgery.

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Continuous postoperative monitoring of cutaneous free flaps using near infrared spectroscopy

Cited by 136 publications

References 33 publications

A critical evaluation of the concomitant use of the implantable Doppler probe and the Vacuum Assisted Closure system in free tissue transfer

A critical evaluation of the concomitant use of the implantable Doppler probe and the Vacuum Assisted Closure system in free tissue transfer

Diffuse Reflectance Spectroscopy for Surface Measurement of Liver Pathology

Evaluation of Flap Tissue Viability by F-18 FDG PET/CT

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