Adipofascial Flap Monitoring Using Masimo Regional Oximetry: A Case Report and Literature Review on Near-Infrared
Zhen Luan Low1, Nadia Hui Shan Sim1, Allen Wei Jiat Wong1
1Plastic, Reconstructive, and Aesthetic Surgery Service, Sengkang General Hospital, Singapore, Singapore.
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Non-invasive monitoring with near-infrared spectroscopy (NIRS) has not been described in the monitoring of non-cutaneous flaps. We present a 29-year-old female with a traumatic left foot injury, where reconstruction was done with a right free adipofascial anterolateral thigh flap. A Masimo O3™ Regional Oximetry pediatric sensor probe was applied directly over the skin-grafted adipofascial flap for continuous flap monitoring and removed at postoperative day 7 uneventfully. We postulate that NIRS does not necessarily require a skin interface, as measurement depends on tissue thickness and penetration of near-infrared wavelengths. A limitation would be the lack of an optimal threshold for regional tissue oxygenation values, but it is reasonable to adopt a threshold of less than 60% absolute value or more than 20% drop from baseline. NIRS has the potential to monitor non-cutaneous flaps as it can detect deep tissue microvascular changes and provide information on tissue perfusion both accurately and non-invasively.
