Application of a new laser Doppler imaging system in planning and monitoring of surgical flaps.
There is a demand for technologies able to assess the perfusion of surgical flaps quantitatively and reliably to avoid ischemic complications. The aim of this study is to test a new high-speed high-definition laser Doppler imaging (LDI) system (FluxEXPLORER, Microvascular Imaging, Lausanne, Switzerland) in terms of preoperative mapping of the vascular supply (perforator vessels) and postoperative flow monitoring. The FluxEXPLORER performs perfusion mapping of an area 9 x 9 cm with a resolution of 256 x 256 pixels within 6 s in high-definition imaging mode. The sensitivity and predictability to localize perforators is expressed by the coincidence of preoperatively assessed LDI high flow spots with intraoperatively verified perforators in nine patients. 18 free flaps are monitored before, during, and after total ischemia. 63% of all verified perforators correspond to a high flow spot, and 38% of all high flow spots correspond to a verified perforator (positive predictive value). All perfused flaps reveal a value of above 221 perfusion units (PUs), and all values obtained in the ischemic flaps are beneath 187 PU. In summary, we conclude that the present LDI system can serve as a reliable, fast, and easy-to-handle tool to detect ischemia in free flaps, whereas perforator vessels cannot be detected appropriately.
Schlosser
Stefan
S
University of Bern, Department of Plastic, Reconstructive and Hand Surgery Inselspital and Department of Clinical Research, CH-3010 Bern, Switzerland.
Wirth
Raphael
R
Plock
Jan A
JA
Serov
Alexandre
A
Banic
Andrej
A
Erni
Dominique
D
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D005260:Female; D006801:Humans; D007511:Ischemia / Q000517:prevention & control; D017078:Laser-Doppler Flowmetry / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D013524:Surgical Flaps / Q000098:blood supply*