Regional Oxygen Saturation Index: A Novel Criterion for Free Flap Assessment Using Tissue Oximetry

Akita, Shinsuke; Mitsukawa, Nobuyuki; Tokumoto, Hideki; Kubota, Yoshitaka; Kuriyama, Masafumi; Sasahara, Yoshitaro; Yamaji, Yoshihisa; Satoh, Kaneshige

doi:10.1097/prs.0000000000002498

Cited by 31 publications

(15 citation statements)

References 36 publications

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“…They combined regional oxygen saturation monitoring with ICG-angiography. The regional oxygen saturation sensor was placed onto an intraoperatively localised ICG angiographically early-staining area 33 . With that Akita et al described an AUROC of 1.0 for their developed oxygen saturation index.…”

Section: Discussionmentioning

confidence: 99%

A comparative analysis using flowmeter, laser-Doppler spectrophotometry, and indocyanine green-videoangiography for detection of vascular stenosis in free flaps

Mücke

Hapfelmeier

Schmidt

et al. 2020

Sci Rep

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The effects of gradual vascular occlusion on the blood supply of perfused areas are poorly described. Information relating to the comparison of flap monitoring techniques is lacking. Varying stenotic conditions (0%, 25%, 50%, 75% and 100%) were generated on purpose at the A. and V. femoralis in the rat model. Analyses included flowmeter, simultaneous laser-Doppler flowmetry and tissue spectrophotometry (O2C) and indocyanine green-(ICG-) videoangiography with integrated FLOW 800 tool. A Random Forests prediction model was used to analyse the importance of each method to diagnose the stenotic conditions. The ability to discriminate and to accurately estimate the probability of stenosis was assessed by Receiver Operating Characteristic (ROC) curves and calibration plots. Blood flow changes for all modalities were described in detail. Flowmeter displayed earliest a linear decrease as a result of increasing stenosis. A stenosis of 50% degrees was most difficult to detect correctly. The combination of flowmeter and ICG-videoangiography showed high diagnostic power for each stenotic situation (area under the Roc > 0.79). Flowmeter and ICG-videoangiography showed to be most relevant in detection of varying stenotic conditions and may change the clinical outcome. The O2C showed less effect on varying stenotic situations as the only surface monitoring device. The microvascular free tissue transfer has revolutionised reconstructive microsurgery and has improved the patients' functional outcome 1. Despite the well documented co-morbidities of patients undergoing head and neck surgery, free flap surgery has contributed to a continuous improvement in the patient-reported and clinical outcomes 2-4. Due to the significant patient co-morbidities and the complexity of the operations, this patient cohort has a high free flap failure rate. A successful outcome necessitates a detailed pre-, intra-and postoperative patient screening in addition to the free flap monitoring, for at least the first 72 hours, postoperatively. The reasons for free flap failures are commonly vascular (thrombosis, endothelial damage) or extravascular, (hematoma, kinking, twisting) in origin. Flap necrosis invariably leads to a prolonged hospital stay and may result in mortality due to poor physiological reserves. There is a definitive window of surgical intervention that must not be missed, for the salvage operation to be successful 5,6. For this reason, the routine postoperative free flap monitoring has to be effective, reproducible and reliable. Free flap monitoring techniques vary and may include the clinical observation, pinprick testing and handheld Doppler 7. More sophisticated, objective methods include simultaneous

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Section: Discussionmentioning

confidence: 99%

A comparative analysis using flowmeter, laser-Doppler spectrophotometry, and indocyanine green-videoangiography for detection of vascular stenosis in free flaps

Mücke

Hapfelmeier

Schmidt

et al. 2020

Sci Rep

View full text Add to dashboard Cite

show abstract

“…Accurate and timely recognition of compromise enabled the flap salvage, which can increase the flap survival rate. Various adjunctive monitoring methodologies have been studied to facilitate more rapid and definite monitoring than clinical examinations, including implantable Doppler, tissue oximetry, microdialysis, and color duplex sonography . However, these approaches have several limitations, such as high cost, difficulty in performing the examination, and interexaminer variance; hence, they are not widely used .…”

Section: Discussionmentioning

confidence: 99%

“…2,22,35,36 However, not all reports demonstrated statistical significance 35,36 and the warning threshold values of tissue oximetry were not consistent between the studies. 20 As such, clinical examination remains the most reliable method of flap monitoring. 8 However, in case of a buried free flap, it is impossible to monitor a free flap only with clinical examination.…”

Section: Discussionmentioning

confidence: 99%

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Effectiveness of small monitoring skin paddle in free muscle flap for scalp reconstruction

et al. 2018

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“…37 Salgarello et al described a negative relationship between regional oxygen saturation and body mass index, as well as flap size, and suggested the current NIRS thresholds may need to be reevaluated in patients with high body fat content. 38 Perhaps the most prohibitive flaw to NIRS monitoring is expense as reported costs range from $8,000 to 50,000 per unit. 3 33 34 36 It has yet to bet determined whether the hospital cost savings can offset the expense associated with currently available NIRS flap monitoring technology.…”

Section: Transcutaneous Oxygen Monitoringmentioning

confidence: 99%

Flap Monitoring Using Transcutaneous Oxygen or Carbon Dioxide Measurements

Halani

Hembd

et al. 2022

Journal of Hand and Microsurgery

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Free tissue transfer is a cornerstone of complex reconstruction. In many cases, it represents the last option available for a patient and their reconstruction. At high-volume centers, the risk of free flap failure is low but its occurrence can be devastating. Currently, the mainstay for flap monitoring is the clinical examination. Though reliable when performed by experienced clinicians, the flap exam is largely subjective, is performed discontinuously, and often results in significant time delay between detection of flap compromise and intervention. Among emerging flap monitoring technologies, the most promising appear to be those that rely on noninvasive transcutaneous oxygen and carbon dioxide measurements, which provide information regarding flap perfusion. In this article, we review and summarize the literature on various techniques but primarily emphasizing those technologies that rely on transcutaneous gas measurements. We also define characteristics for the ideal flap monitoring tool and discuss critical barriers, predominantly cost, preventing more widespread utilization of adjunct monitoring technologies, and their implications.

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Regional Oxygen Saturation Index: A Novel Criterion for Free Flap Assessment Using Tissue Oximetry

Abstract: Diagnostic, II.

Cited by 31 publications

References 36 publications

A comparative analysis using flowmeter, laser-Doppler spectrophotometry, and indocyanine green-videoangiography for detection of vascular stenosis in free flaps

A comparative analysis using flowmeter, laser-Doppler spectrophotometry, and indocyanine green-videoangiography for detection of vascular stenosis in free flaps

Effectiveness of small monitoring skin paddle in free muscle flap for scalp reconstruction

Flap Monitoring Using Transcutaneous Oxygen or Carbon Dioxide Measurements

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