Diagnostical accuracy of hyperspectral imaging after free flap surgery

Torsten Schulz; Rima Nuwayhid; Khosrow Siamak Houschyar; Stefan Langer; Lukas Kohler

doi:10.2340/jphs.v58.7140

Authors

Torsten Schulz Department of Orthopedic, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
Rima Nuwayhid Department of Orthopedic, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
Khosrow Siamak Houschyar Hautzentrum Köln, Cologne, Germany
Stefan Langer Department of Orthopedic, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
Lukas Kohler Department of Orthopedic, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany; Division of Hand-, Plastic- and Aesthetic Surgery, University Hospital Munich, Munich, Germany

DOI:

https://doi.org/10.2340/jphs.v58.7140

Keywords:

Hyperspectral imaging, free flap, malperfusion, venous congestion

Abstract

Microsurgical free-tissue transfer has been a safe option for tissue reconstruction. This study aimed to analyze the diagnostic accuracy of hyperspectral imaging (HSI) after free-tissue transfer surgery. From January 2017 to October 2019, 42 consecutive free-flap surgeries were performed, and their outcomes were analyzed via HSI. Clinical examination of free-flap perfusion was initially performed. Clinical examination findings were subsequently compared with those of HSI. Potential venous congestion with subsequent necrosis was defined as a tissue hemoglobin index of ≥53%. Student’s t-test was used to compare the results of the analysis. The evaluation of sensitivity and specificity for flap failure detection was time dependent using the Fisher’s exact test. A p-value of ≤0.05 was considered statistically significant. Microsurgical tissue transfer success rate was 84%. Seven patients presented with venous congestion that caused total flap necrosis. Overall, 124 assessments were made. HSI accurately identified 12 out of 19 pathological images: four as false positive and seven as false negative. The sensitivity and specificity of HSI were 57 and 94%, respectively, compared to those of clinical examination that were 28 and 100%, respectively, within 24 h following tissue transfer. The sensitivity and specificity of HSI were 63 and 96%, respectively, compared to those of clinical examination that were 63 and 100%, respectively, within the first 72 h. A tissue hemoglobin index of ≥53% could predict venous congestion after free-flap surgery. HSI demonstrated higher sensitivity than clinical examination within the first 24 h; however, it was not superior compared to clinical findings within 72 h.

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