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Comparative Study
. 2015 Jul;197(1):210-7.
doi: 10.1016/j.jss.2015.03.099. Epub 2015 Apr 4.

Evaluating visual perception for assessing reconstructed flap health

Adrien Ponticorvo  1 , Eren Taydas  1 , Amaan Mazhar  2 , Christopher L Ellstrom  3 , Jonathan Rimler  3 , Thomas Scholz  3 , June Tong  1 , Gregory R D Evans  3 , David J Cuccia  2 , Anthony J Durkin  4
Affiliations
Comparative Study

Evaluating visual perception for assessing reconstructed flap health

Adrien Ponticorvo et al. J Surg Res. 2015 Jul.

Abstract

Background: Detecting failing tissue flaps before they are clinically apparent has the potential to improve postoperative flap management and salvage rates. This study demonstrates a model to quantitatively compare clinical appearance, as recorded via digital camera, with spatial frequency domain imaging (SFDI), a noninvasive imaging technique using patterned illumination to generate images of total hemoglobin and tissue oxygen saturation (stO2).

Methods: Using a swine pedicle model in which blood flow was carefully controlled with occlusion cuffs and monitored with ultrasound probes, throughput was reduced by 25%, 50%, 75%, and 100% of baseline values in either the artery or the vein of each of the flaps. The color changes recorded by a digital camera were quantified to predict which occlusion levels were visible to the human eye. SFDI was also used to quantify the changes in physiological parameters including total hemoglobin and oxygen saturation associated with each occlusion.

Results: There were no statistically significant changes in color above the noticeable perception levels associated with human vision during any of the occlusion levels. However, there were statistically significant changes in total hemoglobin and stO2 levels detected at the 50%, 75%, and 100% occlusion levels for arterial and venous occlusions.

Conclusions: As demonstrated by the color imaging data, visual flap changes are difficult to detect until significant occlusion has occurred. SFDI is capable of detecting changes in total hemoglobin and stO2 as a result of partial occlusions before they are perceivable, thereby potentially improving response times and salvage rates.

Keywords: Color perception; Flap reconstruction; Spatial frequency domain imaging.

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Figures

Fig 1
Fig 1
Photograph of a) top view and b) underside of typical swine pedicle flap preparation with instrumentation labeled. Time course of blood flow changes during a series of typical c) arterial and d) venous partial occlusions.
Fig 2
Fig 2
Diagram of imaging system and feedback occlusion system.
Fig. 3
Fig. 3
Color images, overlayed ΔE images, and overlayed ΔHbT images at different time points corresponding to different occlusion levels from a venous occlusion experiment that showed the most significant color changes.
Fig. 4
Fig. 4
Color images, overlayed ΔE images, and overlayed ΔHbT images at different time points corresponding to different occlusion levels from a venous occlusion experiment that showed the least significant color changes.
Fig. 5
Fig. 5
The time courses of a) ΔE and b) HbT changes across all venous occlusion experiments. Statistically significant changes at a given occlusion level are marked with an asterisk.
Fig. 6
Fig. 6
Color images, overlayed ΔE images, and overlayed ΔstO2 images at different time points corresponding to different occlusion levels from a typical arterial occlusion experiment.
Fig. 7
Fig. 7
The time courses of a) ΔE and b) stO2 changes across all arterial occlusion experiments. Statistically significant changes at a given occlusion level are marked with an asterisk.
See this image and copyright information in PMC

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