Current evidence on the use of near-infrared spectroscopy for postoperative free flap monitoring: A systematic review

Background: Although the surgical outcomes of free flap reconstruction have improved over time, vascular compromise remains a devastating complication. Near-infrared spectroscopy(NIRS) is a promising new free flap monitoring technique with the potential for better outcomes than clinical monitoring(CM). This systematic review aims to provide a comprehensive review of the current evidence regarding the use of NIRS for free flap monitoring.Methods: A systematic literature review was performed, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, on existing NRIS studies, including the clinical outcomes of NIRS monitoring, speed of detection, diagnostic accuracy, variables affecting NIRS accuracy, and cost-effectiveness.Results: A total of 24 articles were included in this analysis. In most instances of flap compromise, NIRS enabled earlier detection of compromise than did CM, by an average of 8.1(0.5±32.0) h. The flap salvage rate of flaps monitored with CM and NIRS(87.2%) was significantly higher than that of flaps monitored with CM alone(50.0%)(P<0.01). The overall survival rate for flaps monitored with CM and NIRS(98.1%) was also significantly higher than that for flaps monitored with CM alone(96.3%)(P=0.02). Blood oxygen saturation was the only variable with a significant effect on NIRS results.Conclusion: NIRS is an objective and reliable flap monitoring technique that provides superior flap salvage and survival rates compared with CM, which translates to cost savings and a reduction in workload for healthcare staff. Further large-scale studies are needed to standardize flap compromise criterion values and efficacy for different flap types.

Comparing microsurgical breast reconstruction outcomes following postoperative monitoring techniques:a systematic review and meta-analysis of 2529 patients

Aims:This paper aims to assess the existing evidence regarding oximetry and thermography by comparing postoperative rates of complications following microsurgical breast reconstruction.Methods:A systematic review of PubMed,Web of Science,and Cochrane was completed.A qualitative and quantitative analysis of all included studies was then performed.Results:Fourteen studies were included with a total population of 2,529 female patients who underwent microvascular breast reconstruction,ultimately totaling 3,289 flaps.The mean age for the cohorts included in this study ranged from 48.9 to 57 years of age.A total of 15 complete flap losses were reported.Furthermore,this meta-analysis of proportion showed that total flap loss experienced was 0%(95%CI 0%-100%)for patients monitored with thermography compared to 0%(95%CI 0%-1%)for those monitored with oximetry.Partial flap loss occurred at a frequency of 1%[95%confidence interval(CI)0%-73%]for patients monitored with thermography compared to 1%(95%CI 0%-2%)for those monitored with oximetry.Furthermore,the results of this study showed that thermography prompted a return to the operating room(OR)in 1%(95%CI 0%-73%)of the patients compared to 5%(95%CI 3%-9%)for oximetry.Lastly,the overall complication rate was 12%(95%CI 1%-54%)for patients monitored with thermography compared to 10%(95%CI 4%-21%)for those monitored with oximetry.Conclusion:Ultimately,this meta-analysis concludes that while oximetry monitoring currently has strong evidence for improving flap outcomes,trends in the current data indicate that further studies may demonstrate that thermography may be comparable to oximetry in achieving similar patient outcomes.

Detecting flap compromise:an updated review of techniques to monitor microsurgical flaps postoperatively in breast reconstruction

Breast reconstructive surgery utilizing free tissue transfer has revolutionized the restoration of aesthetic and functional outcomes for patients.Even for the most routine free flap procedures,substantial hospital resources and costs are necessary.The effectiveness of free flap surgery,along with any reconstructive procedure,hinges upon meticulous patient selection,thorough pre-operative planning,well-informed peri-operative decision-making,and diligent post-operative monitoring and care for the patient.This article presents a review of standard clinical care monitoring techniques during the post-operative period,as well as the diverse strategies currently employed for post-operative flap monitoring.

Diagnosis,management and prevention of thrombotic complications in microsurgical breast reconstruction:a review of the literature

Autologous free tissue transfer is a safe and effective option for breast reconstruction.It is an increasingly utilized technique with well-demonstrated improved patient satisfaction and quality of life.Microvascular thrombosis is a rare but significant complication of microsurgical breast reconstruction,often resulting in flap failure.Proper diagnosis and timely management of this complication are essential to free flap salvage.While microvascular thrombosis poses a threat to flap survival,several methods may be employed to mitigate its more devastating effects.Here,we present a comprehensive review of arterial and venous thrombotic complications in both the intraoperative and postoperative settings.We discuss preoperative risk assessment,methods for flap monitoring,and operative and medical management of thrombotic complications.We present an updated algorithm for the intraoperative management of microvascular thrombosis adapted to reflect the most recent literature and our novel algorithm for the postoperative management of microvascular thrombosis.