Near-Infrared Spectroscopy for Continuous Noninvasive Monitoring of Free Flap in Head and Neck Reconstruction: Systematic Review of the Literature and Personal Experience
Case report published in Surgical innovation (2023)
Abstract
BACKGROUND: Buried free flaps represent a reconstructive challenge concerning monitoring of vitality, which is fundamental for an early detection of flap failure and prompt surgical salvage. Many flap monitoring techniques have been developed over time, and there is still no consensus concerning the best monitoring technique for buried reconstructions. METHODS: We performed a systematic review of the literature on NIRS monitoring for head and neck free flaps. Moreover, we presented a case of orbital reconstruction through a buried free myo-fascial anterolateral tight flap (ALTF) in which postoperative monitoring was performed by means of NIRS. RESULTS: Four studies were included with a total of 200 monitored head and neck free flap reconstructions. Flap survival was reported in 96.5% of studies (n = 193/200) with a 3.5% of total flap failure rate (n = 7/200). We monitored the buried myo-fascial ALTF for 7 post-operative days measuring a regional oxygen saturation (rSO2) ranging from 55% to 72% (mean = 66%). CONCLUSIONS: This device appeared to be an efficient choice for monitoring buried flaps, thanks to its ability to measure tissue perfusion deep under the skin, to the continuous availability of recorded data on the monitor, and to its low impact on the patient. Further prospective studies are advised in order to standardize this monitoring technique and define warning values.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Buried free flaps represent a reconstructive challenge concerning monitoring of vitality, which is fundamental for an early detection of flap failure and prompt surgical salvage.
Why This Matters for Hirudotherapy
This systematic review of NIRS monitoring for head and neck free flaps included four studies covering 200 monitored reconstructions with a 96.5% flap survival rate (193/200) and 3.5% total failure rate (7/200), supplemented by the authors' own case of orbital reconstruction with a buried myo-fascial anterolateral thigh flap monitored for 7 postoperative days showing rSO2 values of 55–72% (mean 66%). The authors conclude that NIRS is an efficient choice for monitoring buried flaps due to its deep-tissue penetration capability, continuous data availability, and low patient impact. For ASH's domain, the relevance is indirect—free-flap monitoring relates to reconstructive surgery where leeches may address venous congestion, but this review contains no mention of leeches, hirudotherapy, or anticoagulation. The caveat is that this is a monitoring-technology review with no leech-related content.
Citation
Near-Infrared Spectroscopy for Continuous Noninvasive Monitoring of Free Flap in Head and Neck Reconstruction: Systematic Review of the Literature and Personal Experience
Festa BM et al. · Surgical innovation, 2023
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