New Approach to the Old Challenge of Free Flap Monitoring—Hyperspectral Imaging Outperforms Clinical Assessment by Earlier Detection of Perfusion Failure

In reconstructive surgery, free flap failure, especially in complex osteocutaneous reconstructions, represents a significant clinical burden. Therefore, the aim of the presented study was to assess hyperspectral imaging (HSI) for monitoring of free flaps compared to clinical monitoring. In a prospec...

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Autores principales:	Daniel G. E. Thiem, Paul Römer, Sebastian Blatt, Bilal Al-Nawas, Peer W. Kämmerer
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	HSI objective hyperspectral signature timely recognition reconstruction head and neck Medicine R
Acceso en línea:	https://doaj.org/article/d69ef5da4edd47258b6e4d4ff66227bb
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spelling	oai:doaj.org-article:d69ef5da4edd47258b6e4d4ff66227bb2021-11-25T18:07:11ZNew Approach to the Old Challenge of Free Flap Monitoring—Hyperspectral Imaging Outperforms Clinical Assessment by Earlier Detection of Perfusion Failure10.3390/jpm111111012075-4426https://doaj.org/article/d69ef5da4edd47258b6e4d4ff66227bb2021-10-01T00:00:00Zhttps://www.mdpi.com/2075-4426/11/11/1101https://doaj.org/toc/2075-4426In reconstructive surgery, free flap failure, especially in complex osteocutaneous reconstructions, represents a significant clinical burden. Therefore, the aim of the presented study was to assess hyperspectral imaging (HSI) for monitoring of free flaps compared to clinical monitoring. In a prospective, non-randomized clinical study, patients with free flap reconstruction of the oro-maxillofacial-complex were included. Monitoring was assessed clinically and by using hyperspectral imaging (TIVITA™ Tissue-System, DiaspectiveVision GmbH, Pepelow, Germany) to determine tissue-oxygen-saturation [StO<sub>2</sub>], near-infrared-perfusion-index [NPI], distribution of haemoglobin [THI] and water [TWI], and variance to an adjacent reference area (Δreference). A total of 54 primary and 11 secondary reconstructions were performed including fasciocutaneous and osteocutaneous flaps. Re-exploration was performed in 19 cases. A total of seven complete flap failures occurred, resulting in a 63% salvage rate. Mean time from flap inset to decision making for re-exploration based on clinical assessment was 23.1 ± 21.9 vs. 18.2 ± 19.4 h by the appearance of hyperspectral criteria indicating impaired perfusion (StO<sub>2</sub> ≤ 32% OR StO<sub>2</sub>Δreference > −38% OR NPI ≤ 32.9 OR NPIΔreference ≥ −13.4%) resulting in a difference of 4.8 ± 5 h (<i>p</i> < 0.001). HSI seems able to detect perfusion compromise significantly earlier than clinical monitoring. These findings provide an interpretation aid for clinicians to simplify postoperative flap monitoring.Daniel G. E. ThiemPaul RömerSebastian BlattBilal Al-NawasPeer W. KämmererMDPI AGarticleHSIobjectivehyperspectral signaturetimely recognitionreconstructionhead and neckMedicineRENJournal of Personalized Medicine, Vol 11, Iss 1101, p 1101 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	HSI objective hyperspectral signature timely recognition reconstruction head and neck Medicine R
spellingShingle	HSI objective hyperspectral signature timely recognition reconstruction head and neck Medicine R Daniel G. E. Thiem Paul Römer Sebastian Blatt Bilal Al-Nawas Peer W. Kämmerer New Approach to the Old Challenge of Free Flap Monitoring—Hyperspectral Imaging Outperforms Clinical Assessment by Earlier Detection of Perfusion Failure
description	In reconstructive surgery, free flap failure, especially in complex osteocutaneous reconstructions, represents a significant clinical burden. Therefore, the aim of the presented study was to assess hyperspectral imaging (HSI) for monitoring of free flaps compared to clinical monitoring. In a prospective, non-randomized clinical study, patients with free flap reconstruction of the oro-maxillofacial-complex were included. Monitoring was assessed clinically and by using hyperspectral imaging (TIVITA™ Tissue-System, DiaspectiveVision GmbH, Pepelow, Germany) to determine tissue-oxygen-saturation [StO<sub>2</sub>], near-infrared-perfusion-index [NPI], distribution of haemoglobin [THI] and water [TWI], and variance to an adjacent reference area (Δreference). A total of 54 primary and 11 secondary reconstructions were performed including fasciocutaneous and osteocutaneous flaps. Re-exploration was performed in 19 cases. A total of seven complete flap failures occurred, resulting in a 63% salvage rate. Mean time from flap inset to decision making for re-exploration based on clinical assessment was 23.1 ± 21.9 vs. 18.2 ± 19.4 h by the appearance of hyperspectral criteria indicating impaired perfusion (StO<sub>2</sub> ≤ 32% OR StO<sub>2</sub>Δreference > −38% OR NPI ≤ 32.9 OR NPIΔreference ≥ −13.4%) resulting in a difference of 4.8 ± 5 h (<i>p</i> < 0.001). HSI seems able to detect perfusion compromise significantly earlier than clinical monitoring. These findings provide an interpretation aid for clinicians to simplify postoperative flap monitoring.
format	article
author	Daniel G. E. Thiem Paul Römer Sebastian Blatt Bilal Al-Nawas Peer W. Kämmerer
author_facet	Daniel G. E. Thiem Paul Römer Sebastian Blatt Bilal Al-Nawas Peer W. Kämmerer
author_sort	Daniel G. E. Thiem
title	New Approach to the Old Challenge of Free Flap Monitoring—Hyperspectral Imaging Outperforms Clinical Assessment by Earlier Detection of Perfusion Failure
title_short	New Approach to the Old Challenge of Free Flap Monitoring—Hyperspectral Imaging Outperforms Clinical Assessment by Earlier Detection of Perfusion Failure
title_full	New Approach to the Old Challenge of Free Flap Monitoring—Hyperspectral Imaging Outperforms Clinical Assessment by Earlier Detection of Perfusion Failure
title_fullStr	New Approach to the Old Challenge of Free Flap Monitoring—Hyperspectral Imaging Outperforms Clinical Assessment by Earlier Detection of Perfusion Failure
title_full_unstemmed	New Approach to the Old Challenge of Free Flap Monitoring—Hyperspectral Imaging Outperforms Clinical Assessment by Earlier Detection of Perfusion Failure
title_sort	new approach to the old challenge of free flap monitoring—hyperspectral imaging outperforms clinical assessment by earlier detection of perfusion failure
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/d69ef5da4edd47258b6e4d4ff66227bb
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New Approach to the Old Challenge of Free Flap Monitoring—Hyperspectral Imaging Outperforms Clinical Assessment by Earlier Detection of Perfusion Failure

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