Skin flaps are complex procedures used extensively in reconstructive surgery that require post-operative monitoring to ensure that they do not fail. Near infrared (NIR) spectroscopic imaging is a convenient, non-invasive method for surgeons to examine flaps during surgery and in the early post-operative period. Using a reverse McFarlane skin flap model, we show that model-free chemometric methods as well as simple modified Beer-Lambert analysis of the NIR images provide insights into the blood supply to flaps and demonstrate that the technique can detect and localise perfusion-related complications as well as give real-time feedback to the surgeon as they try to resolve the complication. We also show that using estimates of tissue haemoglobin oxygen saturation, imaging measurements made during surgery and in the early post-operative period are highly predictive of the outcome of the flap tissue with specificities and sensitivities exceeding 85%.
Applications of in vivo near‐infrared (NIR) spectroscopy have emerged in various segments of clinical medicine and medical research. Developments in photonics, wireless connectivity, and smart devices that have been spurred on by the communication revolution have set the stage for even more rapid advancement of noninvasive or minimally invasive medical applications of NIR spectroscopy. The goal of this article is to review the current capabilities and limitations of in vivo NIR spectroscopy and highlight the impact of these capabilities and limitations in selected areas where NIR spectroscopy is being used to address clinical problems. The optical properties of tissues are briefly reviewed as these properties largely dictate the feasibility of an in vivo spectroscopic diagnostic approach and constrain the scope of problems that can be tackled using NIR spectroscopy. Some of the more successful applications of NIR spectroscopy in medicine are described. The number and magnitude of confounding factors that confuse in vivo spectroscopy can be daunting to the experimentalist and may represent the largest barrier in transforming in vivo spectroscopic measurements into clinically meaningful and reliable information. In vivo NIR spectroscopy abounds with opportunity and challenge.
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