Continuous Monitoring of Buried Free Bone Flap Microcirculation in Mandibular Reconstruction Using a Near-Infrared Spectroscopy System.

Postoperative evaluation of free flaps remains a challenging task. The current gold standard for diagnosis of vascular compromise remains clinical observation. In recent years, near-infrared spectroscopy (NIRS) has been widely used as a noninvasive objective monitoring tool for postoperative evaluation of soft tissue flaps. However, methods for monitoring bone flaps are still inadequate. In this study, NIRS was applied for the first time to monitor free buried bone flaps that were used for mandibular reconstruction. The penetrating property of NIRS was used to measure the tissue oxygenation index (TOI) of deep tissues, which reflected the microcirculatory status of the tissues. Changes in TOI values were continuously monitored in 59 cases of free bone flaps, up to 72 hours after surgery. Five cases were diagnosed as vascular compromise by clinical observation. Two fibula flaps were total failure, of which one showed a sharp decrease in TOI value to 45% in a short period of time, while the other showed a continual gradual decrease to 55%. The observed sudden (<50%) and continuous (>10%) decrease in TOI values suggest that more attention should be paid to revision surgeries. In conclusion, the authors concluded that NIRS holds promise as an objective and valid method for clinical evaluation of buried bone flaps.Copyright © 2023 by the American Society of Plastic Surgeons.

Citation

Yixin Ma, Shijun Li, Xiaofeng Shan, Lei Zhang, Zhigang Cai. Continuous Monitoring of Buried Free Bone Flap Microcirculation in Mandibular Reconstruction Using a Near-Infrared Spectroscopy System. Plastic and reconstructive surgery. 2023 May 02

PMID: 37166029

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