A comparative analysis using flowmeter, laser-Doppler |spectrophotometry, and indocyanine green-videoangiography for detection of vascular stenosis in free flaps.
Journal
Scientific reports
ISSN: 2045-2322
Titre abrégé: Sci Rep
Pays: England
ID NLM: 101563288
Informations de publication
Date de publication:
22 01 2020
22 01 2020
Historique:
received:
19
11
2018
accepted:
03
01
2020
entrez:
24
1
2020
pubmed:
24
1
2020
medline:
2
12
2020
Statut:
epublish
Résumé
The effects of gradual vascular occlusion on the blood supply of perfused areas are poorly described. Information relating to the comparison of flap monitoring techniques is lacking. Varying stenotic conditions (0%, 25%, 50%, 75% and 100%) were generated on purpose at the A. and V. femoralis in the rat model. Analyses included flowmeter, simultaneous laser-Doppler flowmetry and tissue spectrophotometry (O2C) and indocyanine green- (ICG-) videoangiography with integrated FLOW 800 tool. A Random Forests prediction model was used to analyse the importance of each method to diagnose the stenotic conditions. The ability to discriminate and to accurately estimate the probability of stenosis was assessed by Receiver Operating Characteristic (ROC) curves and calibration plots. Blood flow changes for all modalities were described in detail. Flowmeter displayed earliest a linear decrease as a result of increasing stenosis. A stenosis of 50% degrees was most difficult to detect correctly. The combination of flowmeter and ICG-videoangiography showed high diagnostic power for each stenotic situation (area under the ROC > 0.79). Flowmeter and ICG-videoangiography showed to be most relevant in detection of varying stenotic conditions and may change the clinical outcome. The O2C showed less effect on varying stenotic situations as the only surface monitoring device.
Identifiants
pubmed: 31969630
doi: 10.1038/s41598-020-57777-2
pii: 10.1038/s41598-020-57777-2
pmc: PMC6976589
doi:
Substances chimiques
Indocyanine Green
IX6J1063HV
Types de publication
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
939Commentaires et corrections
Type : ErratumIn
Références
Clancy, K. et al. Outcomes of microvascular free tissue transfer in twice-irradiated patients. Microsurgery, https://doi.org/10.1002/micr.30154 (2017).
doi: 10.1002/micr.30154
Kesting, M. R. et al. Use of microvascular flap technique in older adults with head and neck cancer: a persisting dilemma in reconstructive surgery? J Am Geriatr Soc 59, 398–405, https://doi.org/10.1111/j.1532-5415.2011.03315.x (2011).
doi: 10.1111/j.1532-5415.2011.03315.x
pubmed: 21391930
Ayala, C. & Blackwell, K. E. Protein C deficiency in microvascular head and neck reconstruction. Laryngoscope 109, 259–265, https://doi.org/10.1097/00005537-199902000-00016 (1999).
doi: 10.1097/00005537-199902000-00016
pubmed: 10890776
Srikanthan, K., Viswanathan, N. & Yuen, J. C. Free-flap failure in thrombophilia: case report and systematic review of the literature. Annals of plastic surgery 71, 675–681, https://doi.org/10.1097/SAP.0b013e3182586b47 (2013).
doi: 10.1097/SAP.0b013e3182586b47
pubmed: 23429221
Farwell, D. G. et al. Predictors of perioperative complications in head and neck patients. Arch Otolaryngol Head Neck Surg 128, 505–511, https://doi.org/10.1001/archotol.128.5.505 (2002).
doi: 10.1001/archotol.128.5.505
pubmed: 12003580
Mücke, T., Schmidt, L. H., Fichter, A. M., Wolff, K.-D. & Ritschl, L. M. Influence of venous stasis on survival of epigastric flaps in rats. The British journal of oral & maxillofacial surgery 56, 310–314, https://doi.org/10.1016/j.bjoms.2018.01.019 (2018).
doi: 10.1016/j.bjoms.2018.01.019
Disa, J. J., Cordeiro, P. G. & Hidalgo, D. A. Efficacy of conventional monitoring techniques in free tissue transfer: an 11-year experience in 750 consecutive cases. Plastic and reconstructive surgery 104, 97–101, https://doi.org/10.1097/00006534-199907000-00013 (1999).
doi: 10.1097/00006534-199907000-00013
pubmed: 10597680
Mücke, T. et al. Identification of perioperative risk factor by laser-doppler spectroscopy after free flap perfusion in the head and neck: a prospective clinical study. Microsurgery 34, 345–351, https://doi.org/10.1002/micr.22206 (2014).
doi: 10.1002/micr.22206
pubmed: 24995717
Um, G. T. et al. Implantable Cook-Swartz Doppler probe versus Synovis Flow Coupler for the post-operative monitoring of free flap breast reconstruction. Journal of plastic, reconstructive & aesthetic surgery: JPRAS 67, 960–966, https://doi.org/10.1016/j.bjps.2014.03.034 (2014).
doi: 10.1016/j.bjps.2014.03.034
pubmed: 24767693
Mericli, A. F. et al. A prospective clinical trial comparing visible light spectroscopy to handheld Doppler for postoperative free tissue transfer monitoring. Plastic and reconstructive surgery, https://doi.org/10.1097/PRS.0000000000003600 (2017).
doi: 10.1097/PRS.0000000000003600
Koolen, P. G. et al. Does Increased Experience with Tissue Oximetry Monitoring in Microsurgical Breast Reconstruction Lead to Decreased Flap Loss? The Learning Effect. Plastic and reconstructive surgery 137, 1093–1101, https://doi.org/10.1097/01.prs.0000481071.59025.82 (2016).
doi: 10.1097/01.prs.0000481071.59025.82
pubmed: 27018663
Just, M. et al. Monitoring of microvascular free flaps following oropharyngeal reconstruction using infrared thermography: first clinical experiences. Eur Arch Otorhinolaryngol 273, 2659–2667, https://doi.org/10.1007/s00405-015-3780-9 (2016).
doi: 10.1007/s00405-015-3780-9
pubmed: 26385810
Teven, C. M., Ooi, A. S. H., Inbal, A. & Chang, D. W. Implantable Doppler monitoring of buried free flaps during vascularized lymph node transfer. J Surg Oncol 116, 371–377, https://doi.org/10.1002/jso.24655 (2017).
doi: 10.1002/jso.24655
pubmed: 28444768
Hitier, M., Cracowski, J. L., Hamou, C., Righini, C. & Bettega, G. Indocyanine green fluorescence angiography for free flap monitoring: A pilot study. J Craniomaxillofac Surg 44, 1833–1841, https://doi.org/10.1016/j.jcms.2016.09.001 (2016).
doi: 10.1016/j.jcms.2016.09.001
pubmed: 27745767
Mücke, T. et al. Indocyanine green videoangiography-assisted prediction of flap necrosis in the rat epigastric flap using the flow(R) 800 tool. Microsurgery 37, 235–242, https://doi.org/10.1002/micr.30072 (2017).
doi: 10.1002/micr.30072
pubmed: 27198708
Patel, U. A. et al. Free Flap Reconstruction Monitoring Techniques and Frequency in the Era of Restricted Resident Work Hours. JAMA Otolaryngol Head Neck Surg 143, 803–809, https://doi.org/10.1001/jamaoto.2017.0304 (2017).
doi: 10.1001/jamaoto.2017.0304
pubmed: 28570718
pmcid: 5710561
Mücke, T., Wolff, K. D., Wagenpfeil, S., Hölzle, F. & Scholz, M. Reliability of near-infrared angiography and micro-Doppler sonography for evaluating microvascular anastomoses. Plastic and reconstructive surgery 126, 1506–1514, https://doi.org/10.1097/PRS.0b013e3181f0215a 00006534-201011000-00011 [pii] (2010).
doi: 10.1097/PRS.0b013e3181f0215a
Holm, C., Mayr, M., Hofter, E., Dornseifer, U. & Ninkovic, M. Assessment of the patency of microvascular anastomoses using microscope-integrated near-infrared angiography: a preliminary study. Microsurgery 29, 509–514, https://doi.org/10.1002/micr.20645 (2009).
doi: 10.1002/micr.20645
pubmed: 19306390
Nasser, A. et al. Utilizing Indocyanine Green Dye Angiography to Detect Simulated Flap Venous Congestion in a Novel Experimental Rat Model. Journal of reconstructive microsurgery 31, 590–596, https://doi.org/10.1055/s-0035-1558869 (2015).
doi: 10.1055/s-0035-1558869
pubmed: 26327578
Holm, C. et al. Intraoperative evaluation of skin-flap viability using laser-induced fluorescence of indocyanine green. Br J Plast Surg 55, 635–644, https://doi.org/10.1054/bjps.2002.3969 (2002).
doi: 10.1054/bjps.2002.3969
pubmed: 12550116
Mücke, T. et al. Objective qualitative and quantitative assessment of blood flow with near-infrared angiography in microvascular anastomoses in the rat model. Microsurgery 33, 287–296, https://doi.org/10.1002/micr.22095 (2013).
doi: 10.1002/micr.22095
pubmed: 23436399
Giunta, R. E. et al. Prediction of flap necrosis with laser induced indocyanine green fluorescence in a rat model. Br J Plast Surg 58, 695–701, https://doi.org/10.1016/j.bjps.2005.02.018 (2005).
doi: 10.1016/j.bjps.2005.02.018
pubmed: 15925341
Bigdeli, A. K. et al. Indocyanine Green Fluorescence for Free-Flap Perfusion Imaging Revisited: Advanced Decision Making by Virtual Perfusion Reality in Visionsense Fusion Imaging Angiography. Surg Innov 23, 249–260, https://doi.org/10.1177/1553350615610651 (2016).
doi: 10.1177/1553350615610651
pubmed: 26474605
Yang, Y., Grosset, D. G., Li, Q., Shuaib, A. & Lees, K. R. Turbulence and circulating cerebral emboli detectable at Doppler ultrasonography: a differentiation study in a stenotic middle cerebral artery model. AJNR Am J Neuroradiol 23, 1229–1236 (2002).
pubmed: 12169484
Schoenberg, S. O., Bock, M., Kallinowski, F. & Just, A. Correlation of hemodynamic impact and morphologic degree of renal artery stenosis in a canine model. J Am Soc Nephrol 11, 2190–2198, 1046-6673/1112-2190 (2000).
Chen, K. T. et al. Timing of presentation of the first signs of vascular compromise dictates the salvage outcome of free flap transfers. Plastic and reconstructive surgery 120, 187–195, https://doi.org/10.1097/01.prs.0000264077.07779.50 (2007).
doi: 10.1097/01.prs.0000264077.07779.50
pubmed: 17572562
Mirzabeigi, M. N. et al. Free flap take-back following postoperative microvascular compromise: predicting salvage versus failure. Plastic and reconstructive surgery 130, 579–589, https://doi.org/10.1097/PRS.0b013e31825dbfb7 (2012).
doi: 10.1097/PRS.0b013e31825dbfb7
pubmed: 22929244
Gimbel, M. L., Rollins, M. D., Fukaya, E. & Hopf, H. W. Monitoring partial and full venous outflow compromise in a rabbit skin flap model. Plastic and reconstructive surgery 124, 796–803, https://doi.org/10.1097/PRS.0b013e3181b03768 (2009).
doi: 10.1097/PRS.0b013e3181b03768
pubmed: 19730298
Weinzweig, N. & Gonzalez, M. Free tissue failure is not an all-or-none phenomenon. Plastic and reconstructive surgery 96, 648–660, https://doi.org/10.1097/00006534-199509000-00018 (1995).
doi: 10.1097/00006534-199509000-00018
pubmed: 7638289
Mücke, T. et al. Changes of perfusion of microvascular free flaps in the head and neck: a prospective clinical study. The British journal of oral & maxillofacial surgery 52, 810–815, https://doi.org/10.1016/j.bjoms.2014.07.001 (2014).
doi: 10.1016/j.bjoms.2014.07.001
Ritschl, L. M. et al. Multimodal analysis using flowmeter analysis, laser-Doppler spectrophotometry, and indocyanine green videoangiography for the detection of venous compromise in flaps in rats. J Craniomaxillofac Surg 46, 905–915, https://doi.org/10.1016/j.jcms.2018.03.016 (2018).
doi: 10.1016/j.jcms.2018.03.016
pubmed: 29661662
Ettinger, K. S. et al. Application of the Surgical Apgar Score to Microvascular Head and Neck Reconstruction. J Oral Maxillofac Surg 74, 1668–1677, https://doi.org/10.1016/j.joms.2016.02.013 (2016).
doi: 10.1016/j.joms.2016.02.013
pubmed: 26997211
Akita, S. et al. Regional Oxygen Saturation Index: A Novel Criterion for Free Flap Assessment Using Tissue Oximetry. Plastic and reconstructive surgery 138, 510e–518e, https://doi.org/10.1097/PRS.0000000000002498 (2016).
doi: 10.1097/PRS.0000000000002498
pubmed: 27556627
Lenz, Y. et al. Evaluation of the Implantable Doppler Probe for Free Flap Monitoring in Lower Limb Reconstruction. Journal of reconstructive microsurgery 34, 218–226, https://doi.org/10.1055/s-0037-1608628 (2018).
doi: 10.1055/s-0037-1608628
pubmed: 29179224
Zhang, F., Sones, W. D. & Lineaweaver, W. C. Microsurgical flap models in the rat. Journal of reconstructive microsurgery 17, 211–221, https://doi.org/10.1055/s-2001-14353 (2001).
doi: 10.1055/s-2001-14353
pubmed: 11336153
Yeoh, M. S., Kim, D. D. & Ghali, G. E. Fluorescence angiography in the assessment of flap perfusion and vitality. Oral Maxillofac Surg Clin North Am 25, 61–66, vi, https://doi.org/10.1016/j.coms.2012.11.004 (2013).
doi: 10.1016/j.coms.2012.11.004
pubmed: 23399396
Ritschl, L. M. et al. Ketamine-Xylazine Anesthesia in Rats: Intraperitoneal versus Intravenous Administration Using a Microsurgical Femoral Vein Access. Journal of reconstructive microsurgery 31, 343–347, https://doi.org/10.1055/s-0035-1546291 (2015).
doi: 10.1055/s-0035-1546291
pubmed: 25702886
Petry, J. J. & Wortham, K. A. The anatomy of the epigastric flap in the experimental rat. Plastic and reconstructive surgery 74, 410–413, https://doi.org/10.1097/00006534-198409000-00014 (1984).
doi: 10.1097/00006534-198409000-00014
pubmed: 6236468
Raabe, A., Beck, J., Gerlach, R., Zimmermann, M. & Seifert, V. Near-infrared indocyanine green video angiography: a new method for intraoperative assessment of vascular flow. Neurosurgery 52, 132–139; discussion 139, https://doi.org/10.1097/00006123-200301000-00017 (2003).
pubmed: 12493110
Close, B. et al. Recommendations for euthanasia of experimental animals: Part 1. DGXI of the European Commission. Lab Anim 30, 293–316, https://doi.org/10.1258/002367796780739871 (1996).
doi: 10.1258/002367796780739871
pubmed: 8938617
Hothorn, T., Hornik, K. & Zeileis, A. Unbiased Recursive Partitioning: A Conditional Inference Framework. Journal of Computational and Graphical Statistics 15, 651–674, https://doi.org/10.1198/106186006x133933 (2006).
doi: 10.1198/106186006x133933
Hapfelmeier, A., Hothorn, T., Ulm, K. & Strobl, C. A New Variable Importance Measure for Random Forests with Missing Data. Stat Comput 24, 21–34, https://doi.org/10.1007/s11222-012-9349-1 (2014).
doi: 10.1007/s11222-012-9349-1