TISSUE OXIMETRY: MONITORING OF MICROSURGICAL FREETISSUE TRANSFERS FOR HEAD AND NECK RECONSTRUCTION
Early detection of vascular compromises in free tissue transfers are required to prevent flap failure. Near-infrared spectroscopy looks as a good sensitive noninvasive technique. But any monitors have difference because of variations in the selected wavelengths. The purpose of this study was to investigate regional oxygenation values (rSO2) by temporary total and venous occlusion model using a noninvasive near-infrared tissue oximeter monitor INVOS 5100С (Somanetics Corporation, Troy, MI, USA) and then to evaluate the detection of vascular complications by oximeter and routine methods in group of patients with free tissue transfer. Material and methods. In 50 healthy adults, near-infrared spectroscopy was used to measure normal regional oxygenation values and during temporary tourniquet total vascular occlusion and venous outflow restriction (150 and 60 mmHg for 10 min). The probe was placed above the brachioradialis muscle in the upper third of the forearm. In group of 52 patients with 53 free flaps for head and neck reconstruction1st sensor was placed above the flap and 2nd contralateral. If we have external skin part of the osteomusculocutaneus flap one more sensor was placed above it. Measurements in patients group performed at mean 3-13 days (obligate time for monitoring is 72 h postoperatively). Statistical comparison of the data was performed using the Friedman test and the Wilcoxon test. Results. Total and venous occlusion showed a mean decrease of the rSO2 values down to (26.4 ± 11.8)% and (43.3 ± 12.3)% respectively. The decrease were significant after 3 minutes of occlusion compared with baseline values (70.1 ± 7.8)%. After statistical analysis we define theoretical critic drop rate - 31 %. The differences between arterial and venous occlusions were statistically significant (p < 0.001). 6 flaps being monitored were lost (4 venous and 2 arterial thromboses). Among the 53 flaps monitored, 6 patients exhibited complications which were predicted by the tissue oximeter before clinical signs have become evident. Early detection of vascular complications has been registered before the clinical manifestation. There have been 5 re-exploration and 4 flaps have survived. Conclusion. Tissue oximetry is sensitive reliable non-invasive instrument with possibility to differentiate arterial and venous occlusion. Limitations are non-working in cases of hematoma or edema and necessity of rSO2 value interpretation according to drop rate, contralateral side and absolute value.
Keywords
слова: тканевая оксиметрия,
оценка жизнеспособности лоскутов,
венозная и артериальная окклюзия,
оксигенация тканей,
неинвазивный мониторинг,
свободный лоскут,
реконструкция головы и шеи,
микрохирургия,
tissue oximetry,
flap monitoring,
venous and arterial occlusion,
tissue oxygenation,
noninvasive monitoring,
nearinfrared,
monitoring blood microcirculation,
free flap,
head and neck reconstruction,
microvascular surgeryAuthors
| Malykhina I. F. | | irinamalyhina@rambler.ru |
| Nerobeyev A. I. | | |
| Dobrodeyev A. S. | | |
| Verbo Ye. V. | | |
| Garelik Ye. I. | | |
| Salikhov K. S. | | |
Всего: 6
References
Вербо Е. В., Неробеев А. И. Реконструкция лица реваскуляризированными аутотрансплантатами. - Тверская область: Медицина; 2008. - 208 с.
Неробеев А. И., Добродеев А. С., Малыхина ИФ, Сомова ММ, Гарелик ЕИ. Критерии выживаемости мышечных лоскутов на основе тканевой соматической оксиметрии // Анналы пластической, реконструктивной и эстетической хирургии. - 2014. - T. 3. - C. 10-18.
Регистрационное удостоверение ФС № 2006/749 от 23.05.2006 г. «Оксиметр церебральный /соматический INVOS 5100C с принадлежностями».
Brown J., Devine J., Magennis P., Sillifant P., Rogers S., Vaughan E. Factors that influence the outcome of salvage in free tissue transfer // Br J Oral Maxillofac Surg. - 2003. - V. 41, № 1. - Р. 16-20.
Cai Z. gang, Zhang J., Zhang J. guo, Zhao F. yun, Yu G. yan, Li Y. et al. Evaluation of near infrared spectroscopy in monitoring postoperative regional tissue oxygen saturation for fibular flaps // J Plast Reconstr Aesthetic Surg. - 2008. - V. 61. - Р. 289-296.
Chen K., Mardini S., Chuang D., Lin C., Cheng M., Lin Y. et al. Timing of presentation of the first signs of vascular compromise dictates the salvage outcome of free flap transfers // Plast Reconstr Surg. - 2007. - V. 120. - P. 187-195.
Colwell A.S., Wright L.R.N., Karanas Y. Near infrared spectroscopy measures tissue oxygenation in free flaps for breast reconstruction // Plast Reconstr Surg. - 2008. - V. 121, № 5. - P. 344-345.
Colwell A.S., Craft R.O. Near-infrared spectroscopy in autologous breast reconstruction // Clin Plast Surg. - 2011. - V. 38. - P. 301-307. 9. Cui W. J., Kumar C., Chance B. Experimental-Study of Migration Depth for the Photons Measured at Sample Surface // Proc SPIE. - 1991. - V. 1431. - Р. 180-191.
De Buysscher P., Veeckman L. BIS and INVOS monitoring: possibilities and limitations in neurosurgery. - N. D. - P. 1-11.
Eckardt A., Meyer A., Laas U., Hausamen J.-E. Reconstruction of defects in the head and neck with free flaps:
years experience // Br J Oral Maxillofac Surg. - 2007. - V. 45. - № 1. - Р. 11-15.
Edmonds L. H. Detection and Correction of Brain Oxygen Imbalance Surgical and Critical Care Applications of the INVOS TM Cerebral Oximeter. - 2014 - Р. 31.
Griffin J.R., Thornton J.F. Microsurgery: Free tissue transfer and replantation // Sel Readings Plast Surg. - 2005. V. 10, № 5 (2). - Р. 39.
Ho M.W., Brown J.S., Magennis P., Bekiroglu F., Rogers S.N., Shaw R.J. et al. Salvage outcomes of free tissue transfer in Liverpool: Trends over 18 years (1992-2009) // Br J Oral Maxillofac Surg. - 2012. - V. 50. - Р. 13-18.
Keller A. A New Diagnostic Algorithm for Early Prediction of Vascular Compromise in 208 Microsurgical Flaps Using Tissue Oxygenation // Ann Plast Surg. - 2009. -V. 62, № 5. - Р. 1-6.
Keller A. Non-invasive Tissue Oximetry for Flap Monitoring: An Initial Study // J Reconstr Microsurg. - 2007. - V. 23, № 212. - Р. 189-197.
Knobloch K., Gohritz A., Meyer-Marcotty M., Spies M., Vogt P. M. letter to the editor: On “Noninvasive Tissue Oximetry for Flap Monitoring: An Initial Study ( J Reconstr Microsurg 2007;23:189-197) // J reconstr Microsurg. - 2008. - V. 24, № 8. - Р. 599-600.
Lin S., Nguyen M., Chen C., Colakoglu S., Curtis M., Tobias A.M. et al. Tissue Oximetry Monitoring in Microsurgical Breast Reconstruction to Decrease Flap Loss // Plast Reconstr Surg. - 2011. - V. 127, № 3. - Р. 1080-1085.
Lohman R., Langevin C., Bozkurt M., Kundu N., Djohan R. A prospective analysis of free flap monitoring techniques: physical examination, external Doppler, implantable Doppler, and tissue oximetry // J Reconstr Microsurg. - 2013. V. 29, № 1. - Р. 51-56.
Muellner T., Nikolic A., Schramm W., Vecsei V. New instrument that uses near-infrared spectroscopy for the monitoring of human muscle oxygenation // J Trauma. - 1999. - V. 46. - Р. 1082-1084.
Novakovic D., Patel R.S., Goldstein D.P., Gullane P.J. Salvage of failed free flaps used in head and neck reconstruction // Head Neck Oncol. - 2009. - V. 1, № 33. - Р. 1-5.
Ozturk C., Ozturk C., Ledinh W., Bozkurt M., Schwarz G., O’Rourke C. et al. Variables affecting postoperative tissue perfusion monitoring in free flap breast reconstruction // Microsurgery. - 2014.
Patterson M. S., Chance B., Wilson B. C. Time resolved reflectance and transmittance for the non-invasive measurement of tissue optical properties // Appl Opt. - 1989. - V. 28, № 12. - Р. 2331-2336.
Repez A., Oroszy D., Arnez Z. M. Continuous postoperative monitoring of cutaneous free flaps using near infrared spectroscopy // J Plast Reconstr Aesthet Surg. - 2008. - V. 61, № 1. - P. 71-77.
Scheufler O., Exner K., Andresen R. Investigation of TRAM flap oxygenation and perfusion by near-infrared reflection spectroscopy and color-coded duplex sonography // Plast Reconstr Surg. - 2004. - V. 113. - P. 141-152. - discussion 153-155.
Shaharin A. Photon time-of-flight and continuous-wave near-infrared-spectroscopy of human skeletal muscle tissue; a comparative study: Masters.s Thesis. - Sweden, 2013. - Р. 52.
Steele M. H. Three-year experience using near infrared spectroscopy tissue oximetry monitoring of free tissue transfers // Ann Plast Surg. - 2011. - V. 66. - P. - 540-545.
Thorniley M. S., Sinclair J. S., Barnett N. J., Shurey C. B., Green C. J. The use of near-infrared spectroscopy for assessing flap viability during reconstructive surgery // Br J Plast Surg. - 1998. - V. 51. - P. 218-226.
Troitzsch D., Moosdorf R., Vogt S. Microvascular tissue oxygenation and oxidative metabolism changes in the pedicled latissimus dorsi muscle during graded hypoxia: correlation between near infrared and 31P nuclear magnetic resonance spectroscopy // J Surg Res. - 2012. - V. 176, № 1. - P. 337-342.
Van Assendelft O. W. Spectrophotometry of hemoglobin derivatives. - Assen, Netherlands: R Vangorcum Ltd, 1970.
Wolf M., Ferrari M., Quaresima V. Progress of near-infrared spectroscopy and topography for brain and muscle clinical applications // J Biomed Opt. - 2007. - V. 12. - № 6. - P. 062104.
Wong C., Wei F. Microsurgical free flap in head and neck reconstruction // Head Neck. - 2010. - V. 32. - P. 1236-1245.
Yu P., Chang D. W., Miller M. J., Reece G., Robb G. L. Analysis of 49 cases of flap compromise in 1310 free flaps for head and neck reconstruction // Head and Neck. - 2009. - P. 45-51.
Zuker R.M., Gur E., Hussain G., Mantkelow R.T. Section II: Head and Neck Reconstruction. In: Rodriguez ED, Losee JE, editors. Plastic Surgery: Craniofacial, Head and Neck Surgery and Pediatric Plastic Surgery. 3rd ed. - London; New York: Elsevier Inc., 2013. - P. 278-307. № 2(53) июнь, 2015 Вопросы реконструктивной и пластической хирургии
Infrared. [Электронный ресурс]. - Электронные данные URL: http://en.wikipedia.org/wiki/Infrared#cite_ note-14 (Дата посещения 02.12.2014).
Near, Mid and Far Infrared [Электронный ресурс]. - Электронные данные URL: http://www.ipac.caltech. edu/outreach/Edu/Regions/irregions.html (Дата посещения 02.12.2014).
Standard ISO 20473:2007. Optics and photonics -- Spectral bands. - 2007. - 8 P. [Электронный ресурс]. - Электронные данные URL: http://www.standards.ru/document/3634100.aspx (Дата посещения 03.02.2015).
The Infrared Region. [Электронный ресурс]. - Электронные данные URL: http://www.nasa.gov/audience/ forstudents/9-12/features/F_The_Infrared_Region.html.
