Near-Infrared Spectroscopy (NIRS) versus Hyperspectral Imaging (HSI) to Detect Flap Failure in Reconstructive Surgery: A Systematic Review.

René R. W. J. van der Hulst,Rutger M. Schols,Anouk A. M. A. Lindelauf,Alexander G. Saelmans,Sander M. J. van Kuijk

doi:10.3390/life12010065

René R. W. J. van der Hulst, Rutger M. Schols + Show 3 more

Open Access

https://doi.org/10.3390/life12010065

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Abstract

Rapid identification of possible vascular compromise in free flap reconstruction to minimize time to reoperation improves achieving free flap salvage. Subjective clinical assessment, often complemented with handheld Doppler, is the golden standard for flap monitoring; but this lacks consistency and may be variable. Non-invasive optical methods such as near-infrared spectroscopy (NIRS) and hyperspectral imaging (HSI) could facilitate objective flap monitoring. A systematic review was conducted to compare NIRS with HSI in detecting vascular compromise in reconstructive flap surgery as compared to standard monitoring. A literature search was performed using PubMed and Embase scientific database in August 2021. Studies were selected by two independent reviewers. Sixteen NIRS and five HSI studies were included. In total, 3662 flap procedures were carried out in 1970 patients using NIRS. Simultaneously; 90 flaps were performed in 90 patients using HSI. HSI and NIRS flap survival were 92.5% (95% CI: 83.3–96.8) and 99.2% (95% CI: 97.8–99.7). Statistically significant differences were observed in flap survival (p = 0.02); flaps returned to OR (p = 0.04); salvage rate (p < 0.01) and partial flap loss rate (p < 0.01). However, no statistically significant difference was observed concerning flaps with vascular crisis (p = 0.39). NIRS and HSI have proven to be reliable; accurate and user-friendly monitoring methods. However, based on the currently available literature, no firm conclusions can be drawn concerning non-invasive monitoring technique superiority

Highlights

One of the most feared complications in reconstructive flap surgery is flap failure as a consequence of microvascular thrombosis
This review aims to compare near-infrared spectroscopy (NIRS) with hyperspectral imaging (HSI) in detecting vascular compromise in reconstructive flap surgery compared to standard monitoring
The following information was extracted: the surname of the first author, country of origin, year of publication, study design, study period, researched monitoring tool, monitoring protocol, study objective, number of patients, number of flaps, age, sex, Body Mass Index (BMI), flap survival, monitoring control technique, bilateral flaps, flap weight, mean ischemia time, types of flaps, vascular disease, diabetes mellitus, smoking, radiotherapy, chemotherapy, prior abdominal surgery, use of inotropes, decisive monitoring tool, warning value, flaps with vascular crisis, flaps returned to OR, salvage rate, average time to discharge, total flap loss rate, partial flap loss rate, sensitivity and specificity

Summary

Introduction

One of the most feared complications in reconstructive flap surgery is flap failure as a consequence of microvascular thrombosis. The ideal method of monitoring would be continuous, non-invasive, sensitive enough to detect vascular compromise instantly, sufficiently reliable to make specialized nursing care dispensable, easy to use, harmless to the patient and flap, applicable to all types of flaps, and inexpensive [4,5,6,7]. Monitoring traditionally consists of the subjective assessment of skin color, capillary refill time, temperature and tissue turgor. Techniques such as handheld Doppler ultrasound, implantable Doppler probes, temperature probes and color duplex sonography are used in conjunction. Differences in level of clinical experience in free flap monitoring of medical staff influences the consistency of recordings and increases variability

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