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Authors: Thiem, Daniel G. E.
Römer, Paul
Blatt, Sebastian
Al-Nawas, Bilal
Kämmerer, Peer W.
Title: New approach to the old challenge of free flap monitoring : hyperspectral imaging outperforms clinical assessment by earlier detection of perfusion failure
Online publication date: 17-Jan-2022
Language: english
Abstract: 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 [StO2], 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 (StO2 ≤ 32% OR StO2Δreference > −38% OR NPI ≤ 32.9 OR NPIΔreference ≥ −13.4%) resulting in a difference of 4.8 ± 5 h (p < 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.
DDC: 610 Medizin
610 Medical sciences
Institution: Johannes Gutenberg-Universität Mainz
Department: FB 04 Medizin
Place: Mainz
Version: Published version
Publication type: Zeitschriftenaufsatz
License: CC BY
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Journal: Journal of Personalized Medicine
Pages or article number: 1101
Publisher: MDPI
Publisher place: Basel
Issue date: 2021
ISSN: 2075-4426
Publisher URL:
Publisher DOI: 10.3390/jpm11111101
Appears in collections:JGU-Publikationen

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