Near-infrared spectroscopy in lower extremity trauma.
BACKGROUND
Near-infrared spectroscopy measures the percentage of hemoglobin oxygen saturation in the microcirculation of tissue up to 3 cm below the skin. The purpose of this study was to describe the measurable response of normal tissue oxygenation in the leg after acute trauma with use of this technique.


METHODS
Twenty-six patients with acute unilateral tibial fractures and twenty-five uninjured volunteer control subjects were enrolled. Near-infrared spectroscopy measurements were obtained for both legs in all four compartments: anterior, lateral, deep posterior, and superficial posterior. The twenty-six injured legs were compared with twenty-five uninjured legs (randomly selected) of the volunteer control group, with the contralateral limb in each patient serving as an internal control.


RESULTS
The mean tissue oxygenation for each compartment in the injured legs was 69% (anterior), 70% (lateral), 74% (deep posterior), and 70% (superficial posterior). In the control (uninjured) legs, the average tissue oxygenation percentage in each compartment was 54%, 55%, 60%, and 57%, respectively. Repeated-measures analysis revealed that near-infrared spectroscopy values averaged 15.4 percentage points (95% confidence interval, 12.2 to 18.6 percentage points) higher for injured legs than for uninjured legs, controlling for the value of the contralateral limb (p < 0.0001).


CONCLUSIONS
Tibial fracture produces a predictable increase in tissue oxygenation as measured by near-infrared spectroscopy. The corresponding compartment of the contralateral leg can provide strong utility as an internal control value when evaluating the hyperemic response to injury.
Shuler
Michael S
MS
Grady Memorial Hospital and Emory University, Atlanta, Georgia, USA. msimmss@hotmail.com
Reisman
William M
WM
Whitesides
Thomas E
TE
Kinsey
Tracy L
TL
Hammerberg
E Mark
EM
Davila
Maria G
MG
Moore
Thomas J
TJ
D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D003161:Compartment Syndromes / Q000175:diagnosis*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007866:Leg / Q000098:blood supply*; D007869:Leg Injuries / Q000175:diagnosis* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008833:Microcirculation / Q000502:physiology; D008875:Middle Aged; D010101:Oxygen Consumption / Q000502:physiology; D011336:Probability; D012016:Reference Values; D012039:Regional Blood Flow; D012680:Sensitivity and Specificity; D019265:Spectroscopy, Near-Infrared; D055815:Young Adult