Remote monitoring of head and neck free flaps using near infrared spectroscopic tissue oximetry

Nicole C. Starr, Emily Slade, Thomas J. Gal, Ayooluwatomiwa Adekunle, Diana Bigler, Brian Cheung, Duane Wang, Melvyn Yeoh, James Liau, Alexandra Kejner

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

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.

Original languageEnglish
Article number102834
JournalAmerican Journal of Otolaryngology - Head and Neck Medicine and Surgery
Volume42
Issue number1
DOIs
StatePublished - Jan 1 2021

Bibliographical note

Funding Information:
After completion of this retrospective study, senior author, Dr. Alexandra Kejner, applied for and received grant funding from Vioptix Inc., Fremont, CA to complete a prospective analysis of NIRS monitoring in head and neck reconstruction. All remaining authors report no declarations of interest.

Funding Information:
The project described was supported by the NIH National Center for Advancing Translational Sciences through grant number UL1TR001998 . The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Funding Information:
The project described was supported by the NIH National Center for Advancing Translational Sciences through grant number UL1TR001998. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Publisher Copyright:
© 2020 Elsevier Inc.

Keywords

  • Free flap
  • Free flap monitoring
  • Head and neck
  • Microvascular surgery
  • Spectroscopy

ASJC Scopus subject areas

  • Otorhinolaryngology

Fingerprint

Dive into the research topics of 'Remote monitoring of head and neck free flaps using near infrared spectroscopic tissue oximetry'. Together they form a unique fingerprint.

Cite this