Intraoperative near-infrared spectroscopy for pedicled perforator flaps: a possible tool for the early detection of vascular issues

Abstract

Background Pedicled perforator flaps can present postoperative complications similar to those encountered in free flap surgery. Beyond a clinical evaluation, there is still no reliable technical aid for the early prediction of vascular issues. The aim of this study was to assess the support of near-infrared spectroscopy technology as an intraoperative tool to anticipate postsurgical flap ischemia.Methods We prospectively enrolled 13 consecutive patients who were referred to our hospital from March 2017 to July 2018 and required a reconstructive procedure with a pedicled fasciocutaneous perforator flap. We measured flap peripheral capillary oxygen saturation (SpO2) in each patient with a Somanetics INVOS 5100C Cerebral/Somatic Oximeter (Medtronic), both before and after transposition. Patient demographics, operative data, and complications were then recorded during the following 6 months. We analyzed the data using the Wilcoxon signed-rank test and linear regression.Results The mean flap SpO2 before and after transposition was 92%±3% and 78%±19%, respectively. The mean change in SpO2 was 14%±17%, with a range of 0% to 55%. The change in saturation and mean saturation ratio were significantly different between patients with and without postoperative flap necrosis.Conclusions An immediate quantitative analysis of flap peripheral capillary SpO2 after transposition has never before been described. In our experience, an intraoperative drop in SpO2 equal to or greater than 15%–20% predicted vascular complications in pedicled perforator flaps. Conversely, flap size and rotation angle were not correlated with the risk of flap necrosis.

Efficacy of Flap-based Posterior Trunk Reconstruction after Vertebrectomy and Radiation Therapy: A Retrospective Cohort Study

“…Flap coverage has shown efficacy and safety [15][16][17] in complex defect reconstruction, offering a more viable solution compared to the use of other products such as dermal matrices. 18 Although different studies are available in the literature reporting the efficacy of flap coverage in defects of the posterior trunk and spine, [19][20][21][22][23][24][25][26][27] they all report the coverage of defects that cannot be closed primarily.…”

Free‐style propeller ulnar artery perforator flaps for radial forearm flap donor site repair

“…A perforator‐based propeller flap usually combines the advantages of pedicled local flaps (good tissue match), pedicled regional flaps (180° arc of rotation), pedicled distant flaps (reliable), and free flaps (tissue away from zone of injury) (Marchesi, Amendola, et al, 2021; Marchesi, Garieri, et al, 2021; Xu et al, 2022). Ulnar perforators can be located proximally to RFFF donor site; consequently, the skin paddle is harvested from the proximal‐middle third of the forearm and its donor site can be easily managed without tendon exposure.…”

Potential role of artificial intelligence in craniofacial surgery

“…In head and neck reconstruction, monitoring of free flaps is performed at 1-hour intervals on postoperative day (POD) 1, at 2-hour intervals on POD 2, and at 4-hour intervals on POD 3–7 by visual examinations or using Doppler ultrasonography [ 45 ]. Reports of flap monitoring using near-infrared spectroscopy (NIRS) in the plastic surgery field have recently been presented [ 46 - 48 ]. The studies reported to date have described NIRS monitoring of flaps used for breast reconstruction.…”