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Hyperspectral analysis for perioperative perfusion monitoring—a clinical feasibility study on free and pedicled flaps

OBJECTIVES: In reconstructive surgery, flap monitoring is crucial for early identification of perfusion problems. Using hyperspectral imaging (HSI), this clinical study aimed to develop a non-invasive, objective approach for perfusion monitoring of free and pedicled flaps. MATERIAL AND METHODS: HSI...

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Autores principales: Thiem, D. G. E., Frick, R. W., Goetze, E., Gielisch, M., Al-Nawas, B., Kämmerer, P. W.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7878271/
https://www.ncbi.nlm.nih.gov/pubmed/32556663
http://dx.doi.org/10.1007/s00784-020-03382-6
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author Thiem, D. G. E.
Frick, R. W.
Goetze, E.
Gielisch, M.
Al-Nawas, B.
Kämmerer, P. W.
author_facet Thiem, D. G. E.
Frick, R. W.
Goetze, E.
Gielisch, M.
Al-Nawas, B.
Kämmerer, P. W.
author_sort Thiem, D. G. E.
collection PubMed
description OBJECTIVES: In reconstructive surgery, flap monitoring is crucial for early identification of perfusion problems. Using hyperspectral imaging (HSI), this clinical study aimed to develop a non-invasive, objective approach for perfusion monitoring of free and pedicled flaps. MATERIAL AND METHODS: HSI of 22 free (FF) and 8 pedicled flaps (PF) in 30 patients was recorded over time. Parameters assessed were tissue oxygenation/superficial perfusion (0–1 mm) (StO(2) (0–100%)), near-infrared perfusion/deep perfusion (0–4 mm) (NIR (0–100)), distribution of haemoglobin (THI (0–100)), and water (TWI (0–100)). Measurements up to 72 h were correlated to clinical assessment. RESULTS: Directly after flap inset, mean StO(2) was significantly higher in FF (70.3 ± 13.6%) compared with PF 56.2 ± 14.2% (p = 0.05), whereas NIR, THI, and TWI were similar (NIR_p = 0.82, THI_p = 0.97, TWI_p = 0.27). After 24 h, StO(2), NIR, THI, and TWI did not differ between FF and PF. After 48 h, StO(2), NIR, and TWI did not differ between FF and PF whereas THI was significantly increased in FF compared with PF(p = 0.001). In three FF, perfusion decreased clinically and in HSI, 36((1)), 40((2)), 5((3)), and 61((3)) h after flap inset which was followed by prompt intervention. CONCLUSIONS: StO(2) < 40%, NIR < 25/100, and THI < 40/100 indicated arterial occlusion, whereas venous problems revealed an increase of THI. In comparison with FF, perfusion parameters of PF were decreased after flap transfer but remained similar to FF later on. CLINICAL RELEVANCE: HSI provides objective and non-invasive perfusion monitoring after flap transplantation in accordance to the clinical situation. With HSI, signs of deterioration can be detected hours before clinical diagnosis. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00784-020-03382-6) contains supplementary material, which is available to authorized users.
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spelling pubmed-78782712021-02-22 Hyperspectral analysis for perioperative perfusion monitoring—a clinical feasibility study on free and pedicled flaps Thiem, D. G. E. Frick, R. W. Goetze, E. Gielisch, M. Al-Nawas, B. Kämmerer, P. W. Clin Oral Investig Original Article OBJECTIVES: In reconstructive surgery, flap monitoring is crucial for early identification of perfusion problems. Using hyperspectral imaging (HSI), this clinical study aimed to develop a non-invasive, objective approach for perfusion monitoring of free and pedicled flaps. MATERIAL AND METHODS: HSI of 22 free (FF) and 8 pedicled flaps (PF) in 30 patients was recorded over time. Parameters assessed were tissue oxygenation/superficial perfusion (0–1 mm) (StO(2) (0–100%)), near-infrared perfusion/deep perfusion (0–4 mm) (NIR (0–100)), distribution of haemoglobin (THI (0–100)), and water (TWI (0–100)). Measurements up to 72 h were correlated to clinical assessment. RESULTS: Directly after flap inset, mean StO(2) was significantly higher in FF (70.3 ± 13.6%) compared with PF 56.2 ± 14.2% (p = 0.05), whereas NIR, THI, and TWI were similar (NIR_p = 0.82, THI_p = 0.97, TWI_p = 0.27). After 24 h, StO(2), NIR, THI, and TWI did not differ between FF and PF. After 48 h, StO(2), NIR, and TWI did not differ between FF and PF whereas THI was significantly increased in FF compared with PF(p = 0.001). In three FF, perfusion decreased clinically and in HSI, 36((1)), 40((2)), 5((3)), and 61((3)) h after flap inset which was followed by prompt intervention. CONCLUSIONS: StO(2) < 40%, NIR < 25/100, and THI < 40/100 indicated arterial occlusion, whereas venous problems revealed an increase of THI. In comparison with FF, perfusion parameters of PF were decreased after flap transfer but remained similar to FF later on. CLINICAL RELEVANCE: HSI provides objective and non-invasive perfusion monitoring after flap transplantation in accordance to the clinical situation. With HSI, signs of deterioration can be detected hours before clinical diagnosis. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00784-020-03382-6) contains supplementary material, which is available to authorized users. Springer Berlin Heidelberg 2020-06-15 2021 /pmc/articles/PMC7878271/ /pubmed/32556663 http://dx.doi.org/10.1007/s00784-020-03382-6 Text en © The Author(s) 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Original Article
Thiem, D. G. E.
Frick, R. W.
Goetze, E.
Gielisch, M.
Al-Nawas, B.
Kämmerer, P. W.
Hyperspectral analysis for perioperative perfusion monitoring—a clinical feasibility study on free and pedicled flaps
title Hyperspectral analysis for perioperative perfusion monitoring—a clinical feasibility study on free and pedicled flaps
title_full Hyperspectral analysis for perioperative perfusion monitoring—a clinical feasibility study on free and pedicled flaps
title_fullStr Hyperspectral analysis for perioperative perfusion monitoring—a clinical feasibility study on free and pedicled flaps
title_full_unstemmed Hyperspectral analysis for perioperative perfusion monitoring—a clinical feasibility study on free and pedicled flaps
title_short Hyperspectral analysis for perioperative perfusion monitoring—a clinical feasibility study on free and pedicled flaps
title_sort hyperspectral analysis for perioperative perfusion monitoring—a clinical feasibility study on free and pedicled flaps
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7878271/
https://www.ncbi.nlm.nih.gov/pubmed/32556663
http://dx.doi.org/10.1007/s00784-020-03382-6
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