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J Reconstr Microsurg 2011; 27(7): 397-402
DOI: 10.1055/s-0031-1281521
© Thieme Medical Publishers

The Use of Visible Light Spectroscopy to Measure Tissue Oxygenation in Free Flap Reconstruction

Agustin Cornejo1 , 2 , Thomas Rodriguez1 , 2 , Megan Steigelman2 , Stacy Stephenson1 , 2 , David Sahar1 , 2 , Stephen M. Cohn2 , Joel E. Michalek3 , Howard T. Wang1 , 2
  • 1Division of Plastic and Reconstructive Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
  • 2Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
  • 3Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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Publication History

Publication Date:
29 June 2011 (online)

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ABSTRACT

The loss of a free flap is a feared complication for both the surgeon and the patient. Early recognition of vascular compromise has been shown to provide the best chance for flap salvage. The ideal monitoring technique for perioperative free flap ischemia would be noninvasive, continuous, and reliable. Visible light spectroscopy (VLS) was evaluated as a new method for predicting ischemia in microvascular cutaneous soft tissue free flaps. In an Institutional Review Board-approved prospective trial, 12 patients were monitored after free flap reconstructions. The tissue hemoglobin oxygen saturation (StO2) and total hemoglobin concentration (THB) of 12 flaps were continuously monitored using VLS for 72 hours postoperatively. Out of these 12 flaps 11 were transplanted successfully and 1 flap loss occurred. The StO2 was 48.99% and the THB was 46.74% for the 12 flaps. There was no significant difference in these values among the flaps. For the single flap loss, the device accurately reflected the ischemic drop in StO2 indicating drastic tissue ischemia at 6 hours postoperatively before the disappearance of implantable Doppler signals or clinical signs of flap compromise. VLS, a continuous, noninvasive, and localized method to monitor oxygenation, appeared to predict early ischemic complications after free flap reconstruction.

KEYWORDS

Visible light spectroscopy - free flap monitoring - free flap reconstruction - postoperative monitoring

REFERENCES

  • 1 Abdel-Galil K, Mitchell D. Postoperative monitoring of microsurgical free tissue transfers for head and neck reconstruction: a systematic review of current techniques—part I. Non-invasive techniques.  Br J Oral Maxillofac Surg. 2009;  47 (5) 351-355
    CrossrefPubMedGoogle Scholar
  • 2 Bakri K, Moran S L. Monitoring for upper-extremity free flaps and replantations.  J Hand Surg Am. 2008;  33 (10) 1905-1908
    CrossrefPubMedGoogle Scholar
  • 3 Chen K T, Mardini S, Chuang D C et al.. Timing of presentation of the first signs of vascular compromise dictates the salvage outcome of free flap transfers.  Plast Reconstr Surg. 2007;  120 (1) 187-195
    CrossrefPubMedGoogle Scholar
  • 4 Disa J J, Cordeiro P G, Hidalgo D A. Efficacy of conventional monitoring techniques in free tissue transfer: an 11-year experience in 750 consecutive cases.  Plast Reconstr Surg. 1999;  104 (1) 97-101
    CrossrefPubMedGoogle Scholar
  • 5 Haddock N T, Gobble R M, Levine J P. More consistent postoperative care and monitoring can reduce costs following microvascular free flap reconstruction.  J Reconstr Microsurg. 2010;  26 (7) 435-439
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Jallali N, Ridha H, Butler P E. Postoperative monitoring of free flaps in UK plastic surgery units.  Microsurgery. 2005;  25 (6) 469-472
    CrossrefPubMedGoogle Scholar
  • 7 Smit J M, Zeebregts C J, Acosta R, Werker P M. Advancements in free flap monitoring in the last decade: a critical review.  Plast Reconstr Surg. 2010;  125 (1) 177-185
    CrossrefPubMedGoogle Scholar
  • 8 Cho B C, Shin D P, Byun J S, Park J W, Baik B S. Monitoring flap for buried free tissue transfer: its importance and reliability.  Plast Reconstr Surg. 2002;  110 (5) 1249-1258
    CrossrefPubMedGoogle Scholar
  • 9 Guillemaud J P, Seikaly H, Cote D, Allen H, Harris J R. The implantable Cook-Swartz Doppler probe for postoperative monitoring in head and neck free flap reconstruction.  Arch Otolaryngol Head Neck Surg. 2008;  134 (7) 729-734
    CrossrefPubMedGoogle Scholar
  • 10 Rosenberg J J, Fornage B D, Chevray P M. Monitoring buried free flaps: limitations of the implantable Doppler and use of color duplex sonography as a confirmatory test.  Plast Reconstr Surg. 2006;  118 (1) 109-113, discussion 114–115
    PubMedGoogle Scholar
  • 11 Rozen W M, Chubb D, Whitaker I S, Acosta R. The efficacy of postoperative monitoring: a single surgeon comparison of clinical monitoring and the implantable Doppler probe in 547 consecutive free flaps.  Microsurgery. 2010;  30 (2) 105-110
    PubMedGoogle Scholar
  • 12 Smit J M, Whitaker I S, Liss A G, Audolfsson T, Kildal M, Acosta R. Post operative monitoring of microvascular breast reconstructions using the implantable Cook-Swartz doppler system: a study of 145 probes & technical discussion.  J Plast Reconstr Aesthet Surg. 2009;  62 (10) 1286-1292
    CrossrefPubMedGoogle Scholar
  • 13 Schmulder A, Gur E, Zaretski A. Eight-year experience of the Cook-Swartz Doppler in free-flap operations: microsurgical and reexploration results with regard to a wide spectrum of surgeries.  Microsurgery. 2011;  31 (1) 1-6
    CrossrefPubMedGoogle Scholar
  • 14 Benaron D A, Parachikov I H, Cheong W F et al.. Design of a visible-light spectroscopy clinical tissue oximeter.  J Biomed Opt. 2005;  10 (4) 44005
    CrossrefPubMedGoogle Scholar
  • 15 Abdel-Galil K, Mitchell D. Postoperative monitoring of microsurgical free-tissue transfers for head and neck reconstruction: a systematic review of current techniques—part II. Invasive techniques.  Br J Oral Maxillofac Surg. 2009;  47 (6) 438-442
    CrossrefPubMedGoogle Scholar
  • 16 Keller A. Noninvasive tissue oximetry for flap monitoring: an initial study.  J Reconstr Microsurg. 2007;  23 (4) 189-197
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Luu Q, Farwell D G. Advances in free flap monitoring: have we gone too far?.  Curr Opin Otolaryngol Head Neck Surg. 2009;  17 (4) 267-269
    CrossrefPubMedGoogle Scholar
  • 18 Benaron D A, Parachikov I H, Friedland S et al.. Continuous, noninvasive, and localized microvascular tissue oximetry using visible light spectroscopy.  Anesthesiology. 2004;  100 (6) 1469-1475
    CrossrefPubMedGoogle Scholar
  • 19 Karliczek A, Benaron D A, Baas P C, Zeebregts C J, Wiggers T, van Dam G M. Intraoperative assessment of microperfusion with visible light spectroscopy for prediction of anastomotic leakage in colorectal anastomoses.  Colorectal Dis. 2010;  12 (10) 1018-1025
    CrossrefPubMedGoogle Scholar
  • 20 Ho J K, Liakopoulos O J, Crowley R et al.. In vivo detection of myocardial ischemia in pigs using visible light spectroscopy.  Anesth Analg. 2009;  108 (4) 1185-1192
    CrossrefPubMedGoogle Scholar
  • 21 Cai Z G, Zhang J, Zhang J G et al.. Evaluation of near infrared spectroscopy in monitoring postoperative regional tissue oxygen saturation for fibular flaps.  J Plast Reconstr Aesthet Surg. 2008;  61 (3) 289-296
    CrossrefPubMedGoogle Scholar
  • 22 Colwell A S, Wright L, Karanas Y. Near-infrared spectroscopy measures tissue oxygenation in free flaps for breast reconstruction.  Plast Reconstr Surg. 2008;  121 (5) 344e-345e
    CrossrefPubMedGoogle Scholar
  • 23 Repez A, Oroszy D, Arnez Z M. Continuous postoperative monitoring of cutaneous free flaps using near infrared spectroscopy.  J Plast Reconstr Aesthet Surg. 2008;  61 (1) 71-77
    CrossrefPubMedGoogle Scholar
  • 24 Spectros. Available at: http://www.spectros.com Accessed August 9, 2010
    Google Scholar
  • 25 Schrey A R, Kinnunen I A, Grénman R A, Minn H R, Aitasalo K M. Monitoring microvascular free flaps with tissue oxygen measurement and PET.  Eur Arch Otorhinolaryngol. 2008;  265 (Suppl 1) S105-S113
    CrossrefPubMedGoogle Scholar
  • 26 Najefi A, Leff D R, Nicolaou M, Nduka C, Yang G Z, Darzi A W. Monitoring of free flaps using near-infrared spectroscopy: a systematic review of the initial trials.  Plast Reconstr Surg. 2010;  125 (4) 182e-184e
    PubMedGoogle Scholar
  • 27 Swartz W M, Izquierdo R, Miller M J. Implantable venous Doppler microvascular monitoring: laboratory investigation and clinical results.  Plast Reconstr Surg. 1994;  93 (1) 152-163
    CrossrefPubMedGoogle Scholar

Howard T WangM.D. 

Chief, Division of Plastic and Reconstructive Surgery

7703 Floyd Curl Drive, San Antonio, TX 78229-3900

Email: wanght@uthscsa.edu

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