Hyperspectral analysis for perioperative perfusion monitoring-a clinical feasibility study on free and pedicled flaps

In reconstructive surgery, flap monitoring is crucial for early identification of perfusion problems. Using hyperspectral imaging (HSI), this clinical study aimed to develop a non-invasive, objective approach for perfusion monitoring of free and pedicled flaps.

HSI of 22 free (FF) and 8 pedicled flaps (PF) in 30 patients was recorded over time. Parameters assessed were tissue oxygenation/superficial perfusion (0-1 mm) (StO₂ (0-100%)), near-infrared perfusion/deep perfusion (0-4 mm) (NIR (0-100)), distribution of haemoglobin (THI (0-100)), and water (TWI (0-100)). Measurements up to 72 h were correlated to clinical assessment.

Directly after flap inset, mean StO₂ was significantly higher in FF (70.3 ± 13.6%) compared with PF 56.2 ± 14.2% (p = 0.05), whereas NIR, THI, and TWI were similar (NIR_p = 0.82, THI_p = 0.97, TWI_p = 0.27). After 24 h, StO₂, NIR, THI, and TWI did not differ between FF and PF. After 48 h, StO₂, NIR, and TWI did not differ between FF and PF whereas THI was significantly increased in FF compared with PF(p = 0.001). In three FF, perfusion decreased clinically and in HSI, 36⁽¹⁾, 40⁽²⁾, 5⁽³), and 61⁽³⁾ h after flap inset which was followed by prompt intervention.

StO₂ < 40%, NIR < 25/100, and THI < 40/100 indicated arterial occlusion, whereas venous problems revealed an increase of THI. In comparison with FF, perfusion parameters of PF were decreased after flap transfer but remained similar to FF later on.

HSI provides objective and non-invasive perfusion monitoring after flap transplantation in accordance to the clinical situation. With HSI, signs of deterioration can be detected hours before clinical diagnosis.