“…Nevertheless, several of the published studies registered an immediate and relevant drop in the flaps' rSO 2 both in case of arterial and venous occlusion, suggesting the actual potential role of NIRS as a valid instrument for early detection of free flap failure. 3,9,10,14,15,[19][20][21][22][23][24][25] Lohman et al 10 interestingly report both a case of venous thrombosis, of venous and arterial abruption, of bleeding from the pedicle's vein, and of pedicle kinking, showing similar drops in the rSO 2 (Table 2). Also, in their study all cases showed recovery of the baseline rSO 2 after surgical flap's salvage.…”
Section: Discussionmentioning
confidence: 90%
“…Then, 202 articles were rejected after title and abstract review and the full text of the remaining 87 papers were obtained and reviewed. Once the inclusion criteria were applied, 8 studies performed between 2008 and 2021 were included in our systematic review, 3,9-15 4 of which described exclusively head and neck reconstruction cases 3,9,11,14 (Table 2). The reasons behind the exclusions of the 59 studies are shown in Figure 1.Figure 1.PRISMA flow diagram.…”
Section: Resultsmentioning
confidence: 99%
“…In the clinical setting, NIRS was first used for continuous noninvasive measurement of cerebral regional oxygen balance. 14 In fact, by recording the relative changes in the concentration of oxygenated (HbO 2 ) and deoxygenated (Hb) hemoglobin and estimating the total tissue hemoglobin concentration (HbT), NIRS can indicate the status of tissue perfusion. 4 At first this technology has been used for monitoring pediatric anesthesia and during carotid endarterectomy in adults, then it has prompted interest in the field of free tissue transfer.…”
Section: Discussionmentioning
confidence: 99%
“…4 At first this technology has been used for monitoring pediatric anesthesia and during carotid endarterectomy in adults, then it has prompted interest in the field of free tissue transfer. 3,4,18 Of notice, out of the 8 studies reporting the use of NIRS for postoperative head and neck free flap monitoring, only the article by Yano et al reports the use of NIRS for postoperative monitoring of buried free flaps, 14 while all the remaining studies include free flaps with an exterior cutaneous island. In their study, Yano et al 14 describe 25 cases of hypopharyngeal/cervical esophageal reconstruction with free jejunal flaps in which postoperative flaps’ regional oxygen saturation was measured using the Brain Oximeter TOS-96 or TOS-OR.…”
Background Buried free flaps represent a reconstructive challenge concerning monitoring of vitality, which is fundamental for an early detection of flap failure and prompt surgical salvage. Many flap monitoring techniques have been developed over time, and there is still no consensus concerning the best monitoring technique for buried reconstructions. Methods We performed a systematic review of the literature on NIRS monitoring for head and neck free flaps. Moreover, we presented a case of orbital reconstruction through a buried free myo-fascial anterolateral tight flap (ALTF) in which postoperative monitoring was performed by means of NIRS. Results Four studies were included with a total of 200 monitored head and neck free flap reconstructions. Flap survival was reported in 96.5% of studies (n = 193/200) with a 3.5% of total flap failure rate (n = 7/200). We monitored the buried myo-fascial ALTF for 7 post-operative days measuring a regional oxygen saturation (rSO2) ranging from 55% to 72% (mean = 66%). Conclusions This device appeared to be an efficient choice for monitoring buried flaps, thanks to its ability to measure tissue perfusion deep under the skin, to the continuous availability of recorded data on the monitor, and to its low impact on the patient. Further prospective studies are advised in order to standardize this monitoring technique and define warning values.
“…Nevertheless, several of the published studies registered an immediate and relevant drop in the flaps' rSO 2 both in case of arterial and venous occlusion, suggesting the actual potential role of NIRS as a valid instrument for early detection of free flap failure. 3,9,10,14,15,[19][20][21][22][23][24][25] Lohman et al 10 interestingly report both a case of venous thrombosis, of venous and arterial abruption, of bleeding from the pedicle's vein, and of pedicle kinking, showing similar drops in the rSO 2 (Table 2). Also, in their study all cases showed recovery of the baseline rSO 2 after surgical flap's salvage.…”
Section: Discussionmentioning
confidence: 90%
“…Then, 202 articles were rejected after title and abstract review and the full text of the remaining 87 papers were obtained and reviewed. Once the inclusion criteria were applied, 8 studies performed between 2008 and 2021 were included in our systematic review, 3,9-15 4 of which described exclusively head and neck reconstruction cases 3,9,11,14 (Table 2). The reasons behind the exclusions of the 59 studies are shown in Figure 1.Figure 1.PRISMA flow diagram.…”
Section: Resultsmentioning
confidence: 99%
“…In the clinical setting, NIRS was first used for continuous noninvasive measurement of cerebral regional oxygen balance. 14 In fact, by recording the relative changes in the concentration of oxygenated (HbO 2 ) and deoxygenated (Hb) hemoglobin and estimating the total tissue hemoglobin concentration (HbT), NIRS can indicate the status of tissue perfusion. 4 At first this technology has been used for monitoring pediatric anesthesia and during carotid endarterectomy in adults, then it has prompted interest in the field of free tissue transfer.…”
Section: Discussionmentioning
confidence: 99%
“…4 At first this technology has been used for monitoring pediatric anesthesia and during carotid endarterectomy in adults, then it has prompted interest in the field of free tissue transfer. 3,4,18 Of notice, out of the 8 studies reporting the use of NIRS for postoperative head and neck free flap monitoring, only the article by Yano et al reports the use of NIRS for postoperative monitoring of buried free flaps, 14 while all the remaining studies include free flaps with an exterior cutaneous island. In their study, Yano et al 14 describe 25 cases of hypopharyngeal/cervical esophageal reconstruction with free jejunal flaps in which postoperative flaps’ regional oxygen saturation was measured using the Brain Oximeter TOS-96 or TOS-OR.…”
Background Buried free flaps represent a reconstructive challenge concerning monitoring of vitality, which is fundamental for an early detection of flap failure and prompt surgical salvage. Many flap monitoring techniques have been developed over time, and there is still no consensus concerning the best monitoring technique for buried reconstructions. Methods We performed a systematic review of the literature on NIRS monitoring for head and neck free flaps. Moreover, we presented a case of orbital reconstruction through a buried free myo-fascial anterolateral tight flap (ALTF) in which postoperative monitoring was performed by means of NIRS. Results Four studies were included with a total of 200 monitored head and neck free flap reconstructions. Flap survival was reported in 96.5% of studies (n = 193/200) with a 3.5% of total flap failure rate (n = 7/200). We monitored the buried myo-fascial ALTF for 7 post-operative days measuring a regional oxygen saturation (rSO2) ranging from 55% to 72% (mean = 66%). Conclusions This device appeared to be an efficient choice for monitoring buried flaps, thanks to its ability to measure tissue perfusion deep under the skin, to the continuous availability of recorded data on the monitor, and to its low impact on the patient. Further prospective studies are advised in order to standardize this monitoring technique and define warning values.
“…Data regarding the first monitoring tool to detect complication was not provided by five studies. A faster detection with standard monitoring was observed in one study and with ICG imaging or standard monitoring in another compared with NIRS [27,28]. HSI was the first tool to indicate a vascular crisis in at least two out of five studies [22,29]; the other three didn't provide data concerning the first tool to detect flap complication (Table 4).…”
Rapid identification of possible vascular compromise in free flap reconstruction to minimize time to reoperation improves achieving free flap salvage. Subjective clinical assessment, often complemented with handheld Doppler, is the golden standard for flap monitoring; but this lacks consistency and may be variable. Non-invasive optical methods such as near-infrared spectroscopy (NIRS) and hyperspectral imaging (HSI) could facilitate objective flap monitoring. A systematic review was conducted to compare NIRS with HSI in detecting vascular compromise in reconstructive flap surgery as compared to standard monitoring. A literature search was performed using PubMed and Embase scientific database in August 2021. Studies were selected by two independent reviewers. Sixteen NIRS and five HSI studies were included. In total, 3662 flap procedures were carried out in 1970 patients using NIRS. Simultaneously; 90 flaps were performed in 90 patients using HSI. HSI and NIRS flap survival were 92.5% (95% CI: 83.3–96.8) and 99.2% (95% CI: 97.8–99.7). Statistically significant differences were observed in flap survival (p = 0.02); flaps returned to OR (p = 0.04); salvage rate (p < 0.01) and partial flap loss rate (p < 0.01). However, no statistically significant difference was observed concerning flaps with vascular crisis (p = 0.39). NIRS and HSI have proven to be reliable; accurate and user-friendly monitoring methods. However, based on the currently available literature, no firm conclusions can be drawn concerning non-invasive monitoring technique superiority
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