The use of near-infrared spectroscopy for assessing flap viability during reconstructive surgery

Thorniley, Maureen S.; Sinclair, Jennifer; Barnett, N. J.; Shurey, C.; Green, C.J.

doi:10.1054/bjps.1997.0145

Cited by 103 publications

(74 citation statements)

References 24 publications

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“…Because NIRS provides measurements at the level of arterioles, capillaries, and venules (1) several centimeters deep in the tissue, it is a complementary method to Doppler, which probes larger blood vessels, laser Doppler flowmetry, which measures superficial blood vessels, and imaging techniques such as magnetic resonance (MR) imaging, positron emission tomography (PET), and radiography, which depend on the use of ionizing radiation and/or contrast media. NIRS has been applied to infants and adults to measure hemodynamics and oxygenation in many fields such as the brain, but one particularly promising field is the skeletal muscle (2)(3)(4)(5). Studies in the skeletal muscle have included measurements in sports medicine (6,7) and in patients with peripheral vascular disease (8 -17), myopathies (18 -20), and heart failure (21)(22)(23).…”

mentioning

confidence: 99%

Regional Differences of Hemodynamics and Oxygenation in the Human Calf Muscle Detected with Near-Infrared Spectrophotometry

Wolf¹,

Wolf²,

Choi³

et al. 2007

Journal of Vascular and Interventional Radiology

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PURPOSE: Measurements in muscle tissue are often performed at a selected single location over the muscle of interest. The hypothesis is that the values obtained reflect the status within the entire muscle or muscle group. This, however, may not be the case. The study was performed to investigate whether this hypothesis is true for hemodynamics and oxygenation in the healthy human calf muscle at rest. MATERIALS AND METHODS:Hemoglobin flow, blood flow, oxygen consumption, and venous hemoglobin oxygen saturation were mapped at 22 locations in 30 legs of 15 healthy subjects (nine women, six men aged 26 -37 years) simultaneously by using frequency-domain near-infrared spectrophotometry with a specially designed probe during venous occlusion. RESULTS: For all parameters, spatial heterogeneity was found between subjects and within individual legs. All parameters were highly significantly different when comparing proximal and distal regions. Differences were also found between medial and lateral regions. The global mean values (؎standard deviation) over all measurements were as follows: hemoglobin flow, 1.27 mol per 100 mL/min ؎ 0.88; blood flow, 0.56 mL per 100 g/min ؎ 0.38; oxygen consumption, 0.016 mL per 100 g/min ؎ 0.011; and venous oxygen saturation, 77.6% ؎ 5.9. The thickness of the overlying adipose tissue had an influence on the measurements and must be considered. CONCLUSION: Highly significant spatial heterogeneity of hemodynamics and oxygenation was found in the healthy human calf muscle. J Vasc Interv Radiol 2007; 18:1094 -1101Abbreviations: ATT ϭ adipose tissue thickness, DPF ϭ differential pathlength factor, NIRS ϭ near-infrared spectrophotometry, SvO 2 ϭ venous oxygen saturation, TRV ϭ test-retest variability, VO 2 ϭ oxygen consumption NEAR-INFRARED spectrophotometry (NIRS) is a valuable tool for measuring hemodynamics and oxygenation in human tissue. NIRS is noninvasive, provides real-time measurements, is costeffective, is feasible at the bedside, and is easily repeatable and reproducible and, therefore, suitable for use in the clinical setting. Because NIRS provides measurements at the level of arterioles, capillaries, and venules (1) several centimeters deep in the tissue, it is a complementary method to Doppler, which probes larger blood vessels, laser Doppler flowmetry, which measures superficial blood vessels, and imaging techniques such as magnetic resonance (MR) imaging, positron emission tomography (PET), and radiography, which depend on the use of ionizing radiation and/or contrast media. NIRS has been applied to infants and adults to measure hemodynamics and oxygenation in many fields such as the brain, but one particularly promising field is the skeletal muscle (2-5). Studies in the skeletal muscle have included measurements in sports medicine (6,7) and in patients with peripheral vascular disease (8 -17), myopathies (18 -20), and heart failure (21-23).Measurements in muscle tissue are often performed at a selected single location over the muscle of interest. The values obtained are consider...

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confidence: 99%

Regional Differences of Hemodynamics and Oxygenation in the Human Calf Muscle Detected with Near-Infrared Spectrophotometry

Wolf¹,

Wolf²,

Choi³

et al. 2007

Journal of Vascular and Interventional Radiology

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“…Although we used a vital dye to assess tissue viability, we did not find this procedure easy to perform or very discriminative. A useful alternative would have been the use of infrared spectroscopy 12 that can give information on tissue viability, but this was not available to us at the time of surgery. In this case, the absence of generalised peritonitis was encouraging.…”

Section: Discussionmentioning

confidence: 99%

Successful myomectomy following infected ischaemic necrosis of uterine fibroids after uterine artery embolisation

Sabatini

Atiomo

Magos

2003

BJOG

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Case reportA 39 year old woman came to the gynaecology clinic with a four year history of pelvic pain and secondary infertility. She had had a miscarriage in the first trimester.One year previously she had undergone open myomectomy. Examination revealed a bulky uterus. An ultrasound scan and magnetic resonance imaging showed a fibroid on the posterior wall of the uterus measuring 9 cm in diameter.She requested uterine artery embolisation as she was keen to avoid repeat surgery and she wanted to preserve her fertility.She underwent uterine artery embolisation using particles of polyvinyl alcohol. She received a single intravenous dose of 1.2 g co-amoxyclav prophylactically before the procedure was started. She went home on the following day.Four weeks after embolisation, she came to the accident and emergency department with a one week history of abdominal pain, fever and an offensive vaginal discharge. Her general practitioner had prescribed antibiotics (375 mg co-amoxyclav three times daily for five days).Her temperature was 38jC and she was tender on abdominal and pelvic examination. Her white blood cell count was 20,300/mL and C-reactive protein was 230 mg/L. An ultrasound scan of her uterus showed a posterior fibroid measuring 13 cm in diameter containing an echogenic linear echo highly suspicious of infection or abscess. Her clinical features also suggested that infection could have complicated the post-embolisation ischaemic necrosis. She was given intravenous antibiotic therapy including cephalosporins and metronidazole. It was decided to perform a laparotomy. During discussions before her operation, she was informed that a hysterectomy could be necessary depending on the operative findings. She made it clear that she wanted us to do everything possible to save her uterus as she was still hoping to conceive.A large necrotic intramural fibroid was detected in the posterior uterine wall extending to the uterine cavity. There were no signs of generalised peritonitis and the uterus did not appear necrotic. The fibroid was shelled out and sent for histopathological examination. Parts of the fibroid and some peritoneal fluid were also sent for microbiological culture. There was minimal bleeding and the posterior uterine wall retained a pinkish colour. Tissue viability was tested by using a vital dye (methylene blue). Debridement was carried out until healthy, bleeding tissue was identified. Debridement appeared to be complete. It was therefore decided not to carry out a hysterectomy and the uterine incision was closed. The debrided wound was irrigated with hydrogen peroxide solution. Intra-abdominal and intrauterine drains were left in situ, the latter being inserted through the uterine incision and pushed down into the vagina.The histological findings revealed an infarcted and partly necrotic leiomyoma, weighing 650 g.Microbiological investigation of the fibroid tissue showed a mixed growth with a prevalence of coliform species. The culture failed to clarify which other organisms were responsible for the infec...

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“…Gastrointestinal tonometry 15 and laser Doppler flowmetry 54 have been used to assess splanchnic perfusion. Microdialysis catheters, 55 near infrared spectroscopy (NIRS), 56 transcutaneous oxygen measurements, 33 and tissue pH monitors 57 have all been used perioperatively to monitor local (surgical site) or general (distant site) tissue perfusion. To date, the majority of these techniques have not been tested in interventional goal-directed fluid therapy trials and their ability to affect outcome remains unclear.…”

Section: 53mentioning

confidence: 99%

The Effects of Fluid Optimization on Outcome Following Major Surgery

Levett

Grocott

Mythen³

2002

Transfus Alt Transfus Med

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The use of near-infrared spectroscopy for assessing flap viability during reconstructive surgery

Cited by 103 publications

References 24 publications

Regional Differences of Hemodynamics and Oxygenation in the Human Calf Muscle Detected with Near-Infrared Spectrophotometry

Regional Differences of Hemodynamics and Oxygenation in the Human Calf Muscle Detected with Near-Infrared Spectrophotometry

Successful myomectomy following infected ischaemic necrosis of uterine fibroids after uterine artery embolisation

The Effects of Fluid Optimization on Outcome Following Major Surgery

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