title: Intraoperative prediction of postoperative flap outcome using the near-infrared fluorophore methylene blue.
abstract: Methylene blue (MB) is a near-infrared fluorophore that provides a stable visual map of skin perfusion after intravenous injection. We explored the capability of MB to predict submental flap postoperative outcome using a single intraoperative measurement. Submental flaps were created in N = 15 pigs and imaged using the FLARE imaging system immediately after surgery and at 72 hours. Using the first 3 pigs, optimal MB dosing was found to be 2.0 mg/kg. Training and validation sets of 6 pigs each were then used for receiver operating characteristic analysis. In the training set, a contrast-to-background ratio (CBR) threshold of 1.24 provided the highest sensitivity and specificity to predict tissue necrosis at 72 hours. In the validation set, this threshold provided a prediction sensitivity of 95.3% and a specificity of 98.0%. We demonstrate that a single intraoperative near-infrared measurement can predict submental flap outcome at 72 hours.
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Yoshitomo
authors.initials: Y
authors.lastname: Ashitate
authors.forename: Bernard T
authors.initials: BT
authors.lastname: Lee
authors.forename: Rita G
authors.initials: RG
authors.lastname: Laurence
authors.forename: Elaine
authors.initials: E
authors.lastname: Lunsford
authors.forename: Merlijn
authors.initials: M
authors.lastname: Hutteman
authors.forename: Rafiou
authors.initials: R
authors.lastname: Oketokoun
authors.forename: Hak Soo
authors.initials: HS
authors.lastname: Choi
authors.forename: John V
authors.initials: JV
authors.lastname: Frangioni
mesh_terms: D000818:Animals; D062109:Dermatologic Surgical Procedures / Q000379:methods*; D005260:Female; D008751:Methylene Blue / Q000008:administration & dosage; D016343:Monitoring, Intraoperative / Q000379:methods*; D009336:Necrosis / Q000175:diagnosis; D061848:Optical Imaging / Q000379:methods*; D010477:Perfusion; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012867:Skin / Q000473:pathology*; D013524:Surgical Flaps / Q000098:blood supply* / Q000473:pathology*; D013552:Swine; D016896:Treatment Outcome
chemical_list: D008751:Methylene Blue