Outcomes of free flap reconstructions with near‐infrared spectroscopy (NIRS) monitoring: A systematic review

Abstract

Background Free flap failure or vascular compromise remains a dreadful complication of microvascular free tissue transfer. Near‐infrared spectroscopy (NIRS) is a novel technique for free flap monitoring that has the propensity for early detection of vascular compromise when compared to the current gold standard, clinical monitoring (CM). The objective of this review is to evaluate the efficacy of a NIRS system in the postoperative monitoring of free flaps and its effect on flap salvage. Methods A comprehensive literature review was performed including English‐language articles evaluating the use of NIRS in free flap monitoring. MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), OVID, and Web of Science were searched upto December 2017. Results A total of 590 articles were identified, and 10 articles were included for analysis. Overall, flaps with vascular compromise monitored with NIRS had a significantly higher salvage rate of 89% compared with a salvage rate of 50% in the flaps monitored by CM alone (p < .01). Partial loss occurred in 15% of the successful salvages in the NIRS group versus 80% with CM alone (p < .01). Detection of vascular compromise by NIRS preceded clinical signs on average by 82 ± 49 min. NIRS was accurate in detecting compromised flaps with a low false‐positive and false‐negative rate. Conclusion Despite lack of robust data, NIRS has the potential to be an objective, accurate, and continuous postoperative free flap monitoring technique with a greater flap salvage rate than CM alone.

Perioperative Tissue Oximetry-driven Fluid Resuscitation Improves Flap Perfusion in Autologous Free Tissue Breast Reconstruction

“…The resulting measures of differing states of hemoglobin concentrations can accurately detect an abnormality of tissue hemodynamics. 10 , 14 Aggressive fluid resuscitation is thought to increase flap edema, causing decreased absorption of infrared hemoglobin chromophores present in the intravascular space. The resulting decrease in T stat readings correlate with local-regional hypoperfusion and in turn may allow NIRS to serve as a parameter by which resuscitation can be guided.…”

Near-Infrared Spectroscopy for Determination of Cardiac Output Augmentation in a Swine Model of Ischemia-Reperfusion Injury

“…Prior reports have validated NIRS to reflect peripheral perfusion during acute compartment syndrome ( 24 ), extracorporeal membrane oxygenation ( 25 , 26 ), free flap reconstruction ( 27 ), and regional anesthesia ( 28 ). Although research into use of NIRS has examined end points of resuscitation and prognostication tools, which is important for the translation from bench to bedside, there has been less work in the area of fluid responsiveness.…”

Transcutaneous CO2 Pressure Monitoring Increases Salvage Rates after Free Tissue Transplantation for Extremity Reconstruction

“…[9][10][11] The ideal monitoring equipment should be noninvasive, easy-to-use, provide real-time flap perfusion data, and have a high level of sensitivity and specificity for detecting impaired blood flow. 11 Takahiko Nakano, MD* Toshiya Kudo, MD, PhD* † Yoshitomo Sano, MD* Hiroaki Minehara, MD, PhD* † Masao Suzuki, MD ‡ Kohei Aoki, MD ‡ Takashi Matsushita, MD, PhD* † Background: Although free tissue transplantation (FTT) is an essential technique in extremity functional reconstruction, postoperative blood flow disturbance is one of the critical complications leading to transplanted tissue necrosis. Early detection of this complication may prevent tissue failure by prompt improvement of blood flow.…”