Monitoring Breast Reconstruction Flaps Using Near-Infrared Spectroscopy Tissue Oximetry

Abstract

Free flap reconstruction is a common procedure with success rates greater than 99%. However, vascular complications may occur, resulting in flap failure. For this reason, early detection of vascular compromise is crucial for flap salvage. Vascular complications may be detected early by monitoring tissue oximetry parameter changes using near-infrared spectroscopy (NIRS). This method of noninvasive monitoring can evaluate changes in flap oxygenation levels caused by arterial and venous thrombosis before surgical reexploration. The goal of this study was to assess the validity of using NIRS oximetry for monitoring free flaps. We conducted a prospective cohort observational study of 10 patients undergoing breast reconstruction. We used the INVOS 7100 cerebral oximetry monitoring system (Medtronic, Dublin, Ireland) to provide 24-hr continuous postoperative monitoring of flap perfusion and compared the data with clinical assessment findings. The median patient age was 57 years (range = 41–61 years). Patients underwent immediate breast reconstruction with deep inferior epigastric perforator (DIEP) flap surgery (n = 4), delayed reconstruction with DIEP flap surgery (n = 4), transverse upper gracilis flap surgery (n = 1), and latissimus dorsi flap with lipofilling (n = 1). We successfully monitored all 10 flaps for 24 hr postoperatively. The overall flap survival rate was 100%. Findings of clinical examination, Doppler studies, and surgical outcome were consistent with NIRS monitoring. In conclusion, NIRS tissue oximetry could potentially provide a noninvasive method for effective postoperative monitoring of free flaps.

Standardized Skin Flap Warming Effectively Improves Flap Survival without Obstructing Temperature Monitoring after DIEP

“…Over the past few decades, many groups developed optimal methodology to monitor and protect transplanted flaps. 19,20 The laser Doppler and laser speckle imaging techniques noninvasively map perfusion dynamics. 21,22 Disadvantages, such as their large size and pricing, make it difficult to use these technologies.…”

Survey of Surgeon-reported Postoperative Protocols for Deep Inferior Epigastric Perforator Flap in Breast Reconstruction

“…2 Balancing costs against salvage benefits, particularly in low-flap-failure institutions, is essential. 10 Although no guideline is suggested, tissue oximetry is noninvasive and cost-effective when used selectively, despite potential false positives. Estimated potential savings are up to $1667 per DIEP flap procedure.…”

Comparing tissue oximetry to doppler monitoring in 1367 consecutive breast free flaps

“…Tissue oximetry (ViOptix, ODISsey™), invented in 1999, introduced a new method of monitoring transferred tissue. Tissue oximetry uses near‐infrared light to measure tissue viability, and the majority of available systems have shown improved patient outcomes when used for free flap monitoring (Arnež et al, 2019; Cornejo et al, 2011; Hölzle et al, 2005; Keller, 2007; Kumbasar et al, 2021; Repež et al, 2008; Schrey et al, 2008; Whitaker et al, 2012; Zg et al, 2008). Benefits reported in previous studies include shorter length of inpatient stay and reduced costs related to shorter intensive care unit stay (Fadavi et al, 2020; Pelletier et al, 2011; Steele, 2011).…”