Remote monitoring of head and neck free flaps using near infrared spectroscopic tissue oximetry
Research article published in American journal of otolaryngology (2020)
Abstract
PURPOSE: Near infrared spectroscopy (NIRS) measures tissue oximetry and perfusion of free tissue transfer with the advantage of remote wireless monitoring for free tissue transfer. It has been widely used in breast and extremity reconstruction but has had limited adoption in the head and neck. MATERIALS AND METHODS: A retrospective review of head and neck microvascular reconstruction by three different surgical services over 15 months at one tertiary care hospital was performed. Demographics, flap type, monitoring technique, complications, and flap outcomes were recorded. Monitoring techniques were (1) implantable/handheld Doppler or (2) NIRS. Flap monitoring outcomes were evaluated using multivariate analysis. RESULTS: 119 flaps were performed by four surgeons with a success rate of 92% (109/119). Flaps were monitored with Doppler (40%) or NIRS (60%). There was no difference in flap success based on monitoring technique. An ROC analysis identified that the optimal cutoff in immediate StO2 for classifying flap success at discharge was 68%. CONCLUSIONS: NIRS was successfully implemented in a high-volume head and neck reconstructive practice. NIRS remote monitoring allowed for flap surveillance without requiring in-hospital presence and was able to identify both arterial and venous compromise.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Peer-reviewed clinical and outcomes research relevant to medicinal leech therapy and its biology. Indexed in PubMed and verified against the NCBI record.
Why This Matters for Hirudotherapy
This retrospective review of 119 head-and-neck microvascular free flaps compared implantable/handheld Doppler with near-infrared spectroscopy (NIRS) tissue oximetry for postoperative flap surveillance, reporting a 92% overall flap success rate, no difference in success by monitoring method, an optimal immediate StO2 cutoff of 68% for predicting success, and the ability of NIRS to detect both arterial and venous compromise remotely. This is genuinely relevant to hirudotherapy because leech therapy is used precisely to rescue free flaps with venous congestion, and early, reliable detection of venous compromise is what triggers timely salvage measures, including leeching. Caveat: this is a single-institution retrospective study of monitoring technology, not of leech therapy; it does not evaluate leeches directly and only establishes context for the surveillance step that precedes a salvage decision.
Citation
Remote monitoring of head and neck free flaps using near infrared spectroscopic tissue oximetry.
Starr et al. · American journal of otolaryngology, 2020
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