Hyperspectral Imaging Detects Clitoral Vascular Issues in Gender-Affirming Surgery

Area of Science:

• Surgical Innovation
• Medical Imaging
• Plastic and Reconstructive Surgery

Background:

• Gender affirmation surgery (GAS) involves complex reconstruction, with clitoral complex perfusion critical for outcomes.
• Assessing intraoperative perfusion is vital to prevent complications like necrosis.
• Current methods for evaluating tissue perfusion may have limitations.

Purpose of the Study:

• To evaluate hyperspectral imaging (HSI) as an intraoperative tool for assessing clitoral complex perfusion during GAS.
• To determine if HSI can predict wound healing or necrosis of the neo-clitoris.
• To establish quantitative perfusion parameters indicative of adverse outcomes.

Main Methods:

• A prospective, non-randomized clinical study involving 30 patients undergoing vaginoplasty with clitoral complex preparation.
• Hyperspectral imaging (HSI) was used to measure tissue perfusion parameters, including oxygen saturation (StO2) and near-infrared perfusion index (NIR PI).
• Patients were categorized into Group A (uneventful healing) and Group B (complete necrosis), with comparative analysis of HSI data.

Main Results:

• No significant differences in patient characteristics were found between groups.
• Clitoral necrosis was associated with both StO2 and NIR PI falling below 40%.
• The simultaneous occurrence of StO2 and NIR PI ≤ 40% demonstrated 92% sensitivity and 72% specificity for predicting necrosis.

Conclusions:

• Hyperspectral imaging (HSI) is a reliable intraoperative modality for predicting clitoral complex necrosis during gender affirmation surgery.
• HSI-derived perfusion parameters, specifically StO2 and NIR PI, can guide surgical decisions to improve patient outcomes.
• This imaging technique offers a promising approach to enhance the safety and success of clitoral reconstruction in GAS.