Adipofascial flap monitoring using Masimo Regional Oximetry: Case report and literature review on Near Infrared Spectroscopy for flap monitoring

Non-invasive monitoring with near infrared spectroscopy (NIRS) not been described in monitoring of non-cutaneous flaps. We present a 29-year-old female with a traumatic left foot injury where reconstruction was done with a right free adipofascial anterolateral thigh flap. A Masimo O3TM Regional Oximetry pediatric sensor probe was applied directly over the skin-grafted adipofascial flap for continuous flap monitoring and removed at post-operative day 7 uneventfully. We postulate that NIRS does not necessarily require a skin interface as measurement depends on tissue thickness and penetration of near-infrared wavelengths. A limitation would be the lack of an optimal threshold for regional tissue oxygenation values but it is reasonable to adopt a threshold of less than 60% absolute value or more than 20% drop from baseline. NIRS has the potential to monitor non-cutaneous flaps as it can detect deep tissue microvascular changes and provide information on tissue perfusion both accurately and non-invasively.

Publication History

Received: 12 December 2024

Accepted after revision: 15 June 2025

Accepted Manuscript online:
30 July 2025