Hyperspektralimaging demonstriert mikrozirkulatorische Effekte postoperativer Ergotherapie bei Patienten mit Morbus Dupuytren

Zusammenfassung

Hintergrund Der Morbus Dupuytren (MD) ist eine häufige Bindegewebserkrankung der Hand. Um ein Rezidiv nach Eingriff zu verhindern, erhalten die Patienten in der Regel eine frühzeitige postoperative Ergotherapie (ET). Der Einfluss dieser Maßnahme auf die Durchblutungssituation und damit auf das Auftreten oder Verhindern postoperativer Komplikationen ist jedoch nicht geklärt. Das Hyperspektralimaging (HSI) erlaubt die quantitative Beurteilung der Gewebsperfusion durch Messung der Sauerstoffsättigung und des Wassergehaltes des Gewebes.

Ziel Evaluation der mikrozirkulatorischen Effekte der frühen postoperativen Ergotherapie nach partieller Fasziektomie bei MD mittels HSI zur Behandlungsoptimierung.

Patienten und Methode Die Sauerstoffsättigung und der Wassergehalt des Gewebes der Hand wurden bei fünf Patienten vor und nach 20 Minuten standarisierter ET am ersten und zweiten postoperativen Tag mittels HSI evaluiert.

Ergebnisse HSI zeigte eine qualitativ und quantitativ verbesserte Perfusion nach ET bei allen Patienten. Nach ET kam es zu einer Verbesserung der Sauerstoffsättigung um 20 % und zu einer Reduktion des Wassergehaltes um bis zu 17 %.

Schlussfolgerung HSI erlaubt die schnelle und nicht-invasive Bestimmung einer verbesserten Sauerstoffversorgung und eines erniedrigten Wassergehaltes im Gewebe des OP-Gebietes bei Patienten nach partieller Fasziektomie bei MD als Folge der ET. Dies kann die Ursache für eine verbesserte Wundheilung und reduzierte Rezidivrate sein.

Abstract

Background Dupuytren’s disease (DD) is a common connective tissue disorder of the hand. To prevent recurrence of contractures, patients usually receive early postoperative ergotherapy (ET). However, it is yet unknown how this measure impacts on local blood flow and hence on the occurrence or prevention of postoperative complications. Hyperspectral imaging (HSI) allows for a quantitative evaluation of tissue perfusion by measuring oxygen saturation and tissue water content.

Objective The aim of this work was to evaluate the microcirculatory effects of early ET after partial fasciectomy in DD using HSI for optimised treatment and prevention.

Patients and Methods In five patients, the oxygen saturation and tissue water content of the hand were measured before and 20 min after exercise therapy on the first two postoperative days using HSI.

Results HSI demonstrated improved tissue perfusion in terms of quantity and quality following ET in all patients. After ET, all patients showed a relative increase in oxygen saturation of up to 20 % and a reduction in tissue water of up to 17 %.

Conclusion HIS allows for a fast and non-invasive evaluation of increased oxygen supply and decreased tissue water content in the surgical site after partial fasciectomy in DD following postoperative exercise therapy. This may improve wound healing and decrease the rate of recurrence in DD.

Schlüsselwörter

Morbus Dupuytren - Ergotherapie - Mikroperfusion - Hyperspektralbildgebung - Gewebeperfusion

Key words

Dupuytren’s disease - ergotherapy - microperfusion - hyperspectral imaging - tissue perfusion

• Literatur

• 1 Lanting R, Broekstra DC, Werker PM. et al. A systematic review and meta-analysis on the prevalence of Dupuytren disease in the general population of Western countries. Plast Reconstr Surg 2014; 133: 593-603
• 2 Bykowski MR, Sivak WN, Cray J. et al. Assessing the impact of antibiotic prophylaxis in outpatient elective hand surgery: a single-center, retrospective review of 8 850 cases. J Hand Surg Am 2011; 36: 1741-1747
• 3 Cheung K, Walley KC, Rozental TD. Management of complications of Dupuytren contracture. Hand clinics 2015; 31: 345-354
• 4 Hohendorff B, Franke J, Spies CK. et al. Operative Behandlung der Dupuytren-Beugekontraktur – Arthrolyse des Fingermittelgelenks. Orthopäde 2017; 46: 328-335
• 5 Huisstede BM, Hoogvliet P, Coert JH. et al. Dupuytren disease: European hand surgeons, hand therapists, and physical medicine and rehabilitation physicians agree on a multidisciplinary treatment guideline: results from the HANDGUIDE study. Plast Reconstr Surg 2013; 132: 964e-976e
• 6 Creutzig A, Dau D, Caspary L. et al. Transcutaneous oxygen pressure measured at two different electrode core temperatures in healthy volunteers and patients with arterial occlusive disease. Int J Microcirc Clin Exp 1987; 5: 373-380
• 7 Dean SM. Cutaneous Manifestations of Chronic Vascular Disease. Prog Cardiovasc Dis 2018; 60: 567-579
• 8 Goldman RJ, Salcido R. More than one way to measure a wound: an overview of tools and techniques. Adv Skin Wound Care 2002; 15: 236-243
• 9 Lal C, Banerjee A, Sujatha NU. Role of contrast and fractality of laser speckle image in assessing flow velocity and scatterer concentration in phantom body fluids. J Biomed Opt 2013; 18: 111419
• 10 Duann JR, Jan CI, Ou-Yang M. et al. Separating spectral mixtures in hyperspectral image data using independent component analysis: validation with oral cancer tissue sections. J Biomed Opt 2013; 18: 126005
• 11 Holmer A, Tetschke F, Marotz J. et al. Oxygenation and perfusion monitoring with a hyperspectral camera system for chemical based tissue analysis of skin and organs. Physiol Meas 2016; 37: 2064-2078
• 12 Sicher C, Rutkowski R, Lutze S. et al. Hyperspectral imaging as a possible tool for visualization of changes in hemoglobin oxygenation in patients with deficient hemodynamics – proof of concept. Biomed Tech (Berl) 2018; 63: 609-616
• 13 Tubiana R, Michon J, Thomine JM. Scheme for the assessment of deformities in Dupuytren’s disease. Surg Clin North Am 1968; 48: 979-984
• 14 Holmer A, Marotz J, Wahl P. et al. Hyperspectral imaging in perfusion and wound diagnostics – methods and algorithms for the determination of tissue parameters. Biomed Tech (Berl) 2018; 63: 547-556
• 15 Yudovsky D, Nouvong A, Pilon L. Hyperspectral imaging in diabetic foot wound care. J Diabetes Sci Technol 2010; 4: 1099-1113
• 16 Luck JV. Dupuytren’s contracture; a new concept of the pathogenesis correlated with surgical management. J Bone Joint Surg Am 1959; 41-a: 635-664
• 17 Hueston JT, Murrell GA. Cell-controlling factors in Dupuytren’s contracture. Ann Chir Main Memb Super 1990; 9: 135-137
• 18 Murrell GA, Francis MJ, Bromley L. Free radicals and Dupuytren’s contracture. Br Med J (Clin Res Ed) 1987; 295: 1373-1375
• 19 Denkler K. Surgical complications associated with fasciectomy for dupuytren’s disease: a 20-year review of the English literature. Eplasty 2010; 10: e15
• 20 Dias JJ, Braybrooke J. Dupuytren’s contracture: an audit of the outcomes of surgery. J Hand Surg Br 2006; 31: 514-521
• 21 Hall PN, Fitzgerald A, Sterne GD. et al. Skin replacement in Dupuytren’s disease. J Hand Surg Br 1997; 22: 193-197
• 22 Lopatecki M. Dupuytren-Kontraktur: Nachbehandlung und Langzeitergebnisse. Orthopäde 2003; 32: 394-396
• 23 Evans RB, Dell PC, Fiolkowski P. A clinical report of the effect of mechanical stress on functional results after fasciectomy for Dupuytren’s contracture. J Hand Ther 2002; 15: 331-339
• 24 Hazarika EZ, Knight MT, Frazer-Moodie A. The effect of intermittent pneumatic compression on the hand after fasciectomy. The Hand 1979; 11: 309-314
• 25 Rendell MS, Green SS, Catania A. et al. Post-exercise cutaneous hyperaemia resulting from local exercise of an extremity. Clin Physiol 1997; 17: 213-224
• 26 Rivlin M, Osterman M, Jacoby SM. et al. The incidence of postoperative flare reaction and tissue complications in Dupuytren’s disease using tension-free immobilization. Hand (N Y) 2014; 9: 459-465
• 27 Jerosch-Herold C, Shepstone L, Chojnowski AJ. et al. Night-time splinting after fasciectomy or dermo-fasciectomy for Dupuytren’s contracture: a pragmatic, multi-centre, randomised controlled trial. BMC Musculoskelet Disord 2011; 12: 136
• 28 Kemler MA, Houpt P, van der Horst CM. A pilot study assessing the effectiveness of postoperative splinting after limited fasciectomy for Dupuytren’s disease. J Hand Surg Eur Vol 2012; 37: 733-737
• 29 Gupta R, Allen F, Tan V. et al. The effect of shear stress on fibroblasts derived from Dupuytren’s tissue and normal palmar fascia. J Hand Surg Am 1998; 23: 945-950
• 30 Daeschlein G, Langner I, Wild T. et al. Hyperspectral imaging as a novel diagnostic tool in microcirculation of wounds. Clin Hemorheol Microcirc 2017; 67: 467-474