Use of Near-infrared Spectroscopy and Implantable Doppler for Postoperative Monitoring of Free Tissue Transfer for Breast Reconstruction: A Systematic Review and Meta-analysis

Berthelot, Melissa; Ashcroft, James; Boshier, Piers R.; Hunter, JO; Henry, Frances; Lo, Benny; Yang, Guang‐Zhong; Leff, Daniel

doi:10.1097/gox.0000000000002437

Cited by 17 publications

(34 citation statements)

References 57 publications

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“…Since its introduction as a monitoring tool for flap viability [4,15], several studies suggested that tissue oximetry could be used as a reliable diagnostic modality for early detection of tissue hypoxia in free flaps [16,17]. To date, no consensus has been established on adequate interpretation strategies of StO 2 data in the clinical setting [15,18]. Nevertheless, among the existing studies the criterion described by Keller et al [17] (StO 2 values below the absolute value of 30%, or a decrease of 20% from baseline values for longer than 60 min in duration, are considered predictors for circulatory compromise and are mostly adopted [6,18,19].…”

Section: Introductionmentioning

confidence: 99%

Exploring personalized postoperative non-invasive tissue oximetry in DIEP flap breast reconstruction

et al. 2021

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Early detection of vascular compromise after autologous breast reconstruction is crucial to enable timely re-exploration for flap salvage. Several studies proposed non-invasive tissue oximetry for early identification of ischemia of deep inferior epigastric perforator (DIEP) flaps. The present study aimed to explore the utility of non-invasive tissue oximetry following DIEP flap surgery using a personalized oxygenation threshold. Methods Patients undergoing immediate/delayed DIEP flap surgery were included in this prospective observational study. DIEP flap tissue oxygenation (StO2) was monitored continuously using near-infrared spectroscopy. A baseline measurement was performed by positioning one sensor at the marked position of the major inferior epigastric perforator on the abdomen. A new sensor was positioned postoperatively on the transplanted tissue. In unilateral procedures, postoperative StO2 values of the native breast were also obtained. Measurements were continued for 24 h. Results Thirty patients (42 flaps) were included. Fourteen patients (46.7%) had an uncomplicated postoperative course. A minor complication was observed in thirteen patients; in five patients, at least one major complication occurred, requiring re-exploration. Median StO2 readings were significantly lower in patients with major complications compared to uncomplicated cases. In fourteen unilateral DIEP flap procedures, StO2 values of the native breast were similar to the preoperative baseline measurement (92%; p = 0.452). Conclusions Non-invasive tissue oximetry following DIEP flap surgery could aid in early detection of vascular compromise. StO2 values of the native breast and abdominal wall preoperatively can be used interchangeably and can serve as personalized reference value. Level of evidence: Level IV, diagnostic / prognostic study.

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Section: Introductionmentioning

confidence: 99%

Exploring personalized postoperative non-invasive tissue oximetry in DIEP flap breast reconstruction

et al. 2021

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“…This obviates the significant concern that the probe might kink, compress, avulse, or otherwise disrupt the anastomosis and threaten the flap. 5,7,8 Second, while implantable Doppler systems generates auditory data which is only available at bedside, the intramuscular NIRS probe generates a continuous StO 2 tracing. This important difference reduces the care burden for bedside personnel, produces a recordable data stream, facilitates remote monitoring, and requires less subjective interpretation which makes it more robust to frequent transitions of care.…”

Section: Potential Advantages Of the Intramuscular Nirs Probementioning

confidence: 99%

Intramuscular Near-Infrared Spectroscopy for Muscle Flap Monitoring in a Porcine Model

Bai

Guo

Ouyang

et al. 2021

J Reconstr Microsurg

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Background Current near-infrared spectroscopy (NIRS)-based systems for continuous flap monitoring are limited to flaps which carry a cutaneous paddle. As such, this useful and reliable technology has not previously been applicable to muscle-only free flaps where other modalities with substantial limitations continue to be utilized. Methods We present the first NIRS probe which allows continuous monitoring of local tissue oxygen saturation (StO2) directly within the substance of muscle tissue. This probe is flexible, subcentimeter in scale, waterproof, biocompatible, and is fitted with resorbable barbs which facilitate temporary autostabilization followed by easy atraumatic removal. This novel device was compared with a ViOptix T.Ox monitor in a porcine rectus abdominus myocutaneous flap model of arterial and venous occlusions. During these experiments, the T.Ox device was affixed to the skin paddle, while the novel probe was within the muscle component of the same flap. Results The intramuscular NIRS device and skin-mounted ViOptix T.Ox devices produced very similar StO2 tracings throughout the vascular clamping events, with obvious and parallel changes occurring upon vascular clamping and release. The normalized cross-correlation at zero lag describing correspondence between the novel intramuscular NIRS and T.Ox devices was >0.99. Conclusion This novel intramuscular NIRS probe offers continuous monitoring of oxygen saturation within muscle flaps. This experiment demonstrates the potential suitability of this intramuscular NIRS probe for the task of muscle-only free flap monitoring, where NIRS has not previously been applicable. Testing in the clinical environment is necessary to assess durability and reliability.

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“…2 Internal Doppler systems [3][4][5] position a wired Doppler probe directly at or adjacent to the anastomosis, and provide a continuous audible signal which is indicative of blood flow. While this may accelerate the process of identifying a malperfused flap and improve flap salvage rate, 6,7 these systems are not well suited to remote monitoring and still require frequent attendance by skilled personnel at bedside. Furthermore, these systems have a high rate of false-positive alarms due to probe disengagement, 8,9 and may cause direct deformation of or trauma to the anastomosis during placement and/or removal.…”

mentioning

confidence: 99%

“…Furthermore, these systems have a high rate of false-positive alarms due to probe disengagement, 8,9 and may cause direct deformation of or trauma to the anastomosis during placement and/or removal. 5,7,8 Recently, near-infrared spectroscopy (NIRS) has gained favor as a strategy for continuous monitoring of cutaneous free flaps. 7,9 This technology is noninvasive and provides objective data which facilitates remote monitoring and reduces the need for skilled personnel at bedside.…”

mentioning

confidence: 99%

“…5,7,8 Recently, near-infrared spectroscopy (NIRS) has gained favor as a strategy for continuous monitoring of cutaneous free flaps. 7,9 This technology is noninvasive and provides objective data which facilitates remote monitoring and reduces the need for skilled personnel at bedside. The T.Ox device (ViOptix Inc., Fremont, CA) is a widely utilized NIRSbased monitor which has demonstrated excellent sensitivity and specificity for the detection of flap compromise.…”

mentioning

confidence: 99%

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A Wireless Near-Infrared Spectroscopy Device for Flap Monitoring: Proof of Concept in a Porcine Musculocutaneous Flap Model

Rwei

Lee

et al. 2021

J Reconstr Microsurg

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Background Current near-infrared spectroscopy (NIRS)-based systems for continuous flap monitoring are highly sensitive for detecting malperfusion. However, the clinical utility and user experience are limited by the wired connection between the sensor and bedside console. This wire leads to instability of the flap–sensor interface and may cause false alarms. Methods We present a novel wearable wireless NIRS sensor for continuous fasciocutaneous free flap monitoring. This waterproof silicone-encapsulated Bluetooth-enabled device contains two light-emitting diodes and two photodetectors in addition to a battery sufficient for 5 days of uninterrupted function. This novel device was compared with a ViOptix T.Ox monitor in a porcine rectus abdominus myocutaneous flap model of arterial and venous occlusions. Results Devices were tested in four flaps using three animals. Both devices produced very similar tissue oxygen saturation (StO2) tracings throughout the vascular clamping events, with obvious and parallel changes occurring on arterial clamping, arterial release, venous clamping, and venous release. Small interdevice variations in absolute StO2 value readings and magnitude of change were observed. The normalized cross-correlation at zero lag describing correspondence between the novel NIRS and T.Ox devices was >0.99 in each trial. Conclusion The wireless NIRS flap monitor is capable of detecting StO2 changes resultant from arterial vascular occlusive events. In this porcine flap model, the functionality of this novel sensor closely mirrored that of the T.Ox wired platform. This device is waterproof, highly adhesive, skin conforming, and has sufficient battery life to function for 5 days. Clinical testing is necessary to determine if this wireless functionality translates into fewer false-positive alarms and a better user experience.

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Use of Near-infrared Spectroscopy and Implantable Doppler for Postoperative Monitoring of Free Tissue Transfer for Breast Reconstruction: A Systematic Review and Meta-analysis

Abstract: Supplemental Digital Content is available in the text.

Cited by 17 publications

References 57 publications

Exploring personalized postoperative non-invasive tissue oximetry in DIEP flap breast reconstruction

Exploring personalized postoperative non-invasive tissue oximetry in DIEP flap breast reconstruction

Intramuscular Near-Infrared Spectroscopy for Muscle Flap Monitoring in a Porcine Model

A Wireless Near-Infrared Spectroscopy Device for Flap Monitoring: Proof of Concept in a Porcine Musculocutaneous Flap Model

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