A Reliable Method for the Monitoring of Buried Free Flaps Using Near-Infrared Spectroscopy
Background In recent years, there has been a shift toward nipple-sparing mastectomy (NSM) techniques which often negates the need for reconstruction with exposed cutaneous donor flap tissues. Although techniques for the monitoring of buried flaps have been proposed, none have been able to provide th...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Georg Thieme Verlag KG
2022-07-01
|
| Series: | Journal of Reconstructive Microsurgery Open |
| Subjects: | |
| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-1757321 |
| _version_ | 1797988447132057600 |
|---|---|
| author | Keith Sweitzer Katherine Carruthers Pankaj Tiwari Ergun Kocak |
| author_facet | Keith Sweitzer Katherine Carruthers Pankaj Tiwari Ergun Kocak |
| author_sort | Keith Sweitzer |
| collection | DOAJ |
| description | Background In recent years, there has been a shift toward nipple-sparing mastectomy (NSM) techniques which often negates the need for reconstruction with exposed cutaneous donor flap tissues. Although techniques for the monitoring of buried flaps have been proposed, none have been able to provide the benefits that come with cutaneous monitoring via near-infrared spectroscopy (NIRS). Therefore, we herein propose a novel method for monitoring deepithelialized flap tissues deep to the mastectomy flaps using NIRS technology.
Methods An NSM with free flap reconstruction was performed. The flap was designed with a skin island for placement of a cutaneous NIRS probe. Next, a silicone NIRS probe was placed on a deepithelialized portion of the flap under the mastectomy flap. The readings from this tunneled device were then compared to the control measurements obtained from the cutaneous NIRS monitor. This procedure was performed on three consecutive patients. The changes in StO2 recorded from both devices were compared using a paired, two-tailed Student's t-test.
Results During flap monitoring, there were no issues with probe dislodgement and signal quality averaged greater than 90. Furthermore, probe removal was easily accomplished at bedside. There was no harm to the mastectomy skin flaps by affixing the probe and the pocket which contained the probe quickly closed down after removal. Using the Student's t-test, a p-value of 0.995 was calculated indicating no statistically significant difference between the StO2 readings from the cutaneous and the tunneled probes.
Conclusion By using this novel method, NIRS technology can reliably be applied to the monitoring of buried free flap tissues. The proposed technique could be applied to a variety of flaps beyond the realm of breast reconstruction and may prove to be particularly useful in the setting of head and neck reconstruction. The results of this study suggest that high quality postoperative flap monitoring is possible without compromising the aesthetic result. |
| first_indexed | 2024-04-11T08:03:08Z |
| format | Article |
| id | doaj.art-e2586a50885d437f9e9b83d15f0707ec |
| institution | Directory Open Access Journal |
| issn | 2377-0813 2377-0821 |
| language | English |
| last_indexed | 2024-04-11T08:03:08Z |
| publishDate | 2022-07-01 |
| publisher | Georg Thieme Verlag KG |
| record_format | Article |
| series | Journal of Reconstructive Microsurgery Open |
| spelling | doaj.art-e2586a50885d437f9e9b83d15f0707ec2022-12-22T04:35:39ZengGeorg Thieme Verlag KGJournal of Reconstructive Microsurgery Open2377-08132377-08212022-07-010702e44e4710.1055/s-0042-1757321A Reliable Method for the Monitoring of Buried Free Flaps Using Near-Infrared SpectroscopyKeith Sweitzer0Katherine Carruthers1Pankaj Tiwari2Ergun Kocak3Division of Plastic Surgery, Strong Memorial Hospital, University of Rochester, Rochester, New YorkDivision of Plastic and Reconstructive Surgery, West Virginia University Health Sciences Center, Morgantown, West VirginiaMidwest Breast & Aesthetic Surgery, Gahanna, OhioMidwest Breast & Aesthetic Surgery, Gahanna, OhioBackground In recent years, there has been a shift toward nipple-sparing mastectomy (NSM) techniques which often negates the need for reconstruction with exposed cutaneous donor flap tissues. Although techniques for the monitoring of buried flaps have been proposed, none have been able to provide the benefits that come with cutaneous monitoring via near-infrared spectroscopy (NIRS). Therefore, we herein propose a novel method for monitoring deepithelialized flap tissues deep to the mastectomy flaps using NIRS technology. Methods An NSM with free flap reconstruction was performed. The flap was designed with a skin island for placement of a cutaneous NIRS probe. Next, a silicone NIRS probe was placed on a deepithelialized portion of the flap under the mastectomy flap. The readings from this tunneled device were then compared to the control measurements obtained from the cutaneous NIRS monitor. This procedure was performed on three consecutive patients. The changes in StO2 recorded from both devices were compared using a paired, two-tailed Student's t-test. Results During flap monitoring, there were no issues with probe dislodgement and signal quality averaged greater than 90. Furthermore, probe removal was easily accomplished at bedside. There was no harm to the mastectomy skin flaps by affixing the probe and the pocket which contained the probe quickly closed down after removal. Using the Student's t-test, a p-value of 0.995 was calculated indicating no statistically significant difference between the StO2 readings from the cutaneous and the tunneled probes. Conclusion By using this novel method, NIRS technology can reliably be applied to the monitoring of buried free flap tissues. The proposed technique could be applied to a variety of flaps beyond the realm of breast reconstruction and may prove to be particularly useful in the setting of head and neck reconstruction. The results of this study suggest that high quality postoperative flap monitoring is possible without compromising the aesthetic result.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-1757321monitoringnirsfree flap |
| spellingShingle | Keith Sweitzer Katherine Carruthers Pankaj Tiwari Ergun Kocak A Reliable Method for the Monitoring of Buried Free Flaps Using Near-Infrared Spectroscopy Journal of Reconstructive Microsurgery Open monitoring nirs free flap |
| title | A Reliable Method for the Monitoring of Buried Free Flaps Using Near-Infrared Spectroscopy |
| title_full | A Reliable Method for the Monitoring of Buried Free Flaps Using Near-Infrared Spectroscopy |
| title_fullStr | A Reliable Method for the Monitoring of Buried Free Flaps Using Near-Infrared Spectroscopy |
| title_full_unstemmed | A Reliable Method for the Monitoring of Buried Free Flaps Using Near-Infrared Spectroscopy |
| title_short | A Reliable Method for the Monitoring of Buried Free Flaps Using Near-Infrared Spectroscopy |
| title_sort | reliable method for the monitoring of buried free flaps using near infrared spectroscopy |
| topic | monitoring nirs free flap |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-1757321 |
| work_keys_str_mv | AT keithsweitzer areliablemethodforthemonitoringofburiedfreeflapsusingnearinfraredspectroscopy AT katherinecarruthers areliablemethodforthemonitoringofburiedfreeflapsusingnearinfraredspectroscopy AT pankajtiwari areliablemethodforthemonitoringofburiedfreeflapsusingnearinfraredspectroscopy AT ergunkocak areliablemethodforthemonitoringofburiedfreeflapsusingnearinfraredspectroscopy AT keithsweitzer reliablemethodforthemonitoringofburiedfreeflapsusingnearinfraredspectroscopy AT katherinecarruthers reliablemethodforthemonitoringofburiedfreeflapsusingnearinfraredspectroscopy AT pankajtiwari reliablemethodforthemonitoringofburiedfreeflapsusingnearinfraredspectroscopy AT ergunkocak reliablemethodforthemonitoringofburiedfreeflapsusingnearinfraredspectroscopy |