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Review
. 2022 Jan 3;12(1):65.
doi: 10.3390/life12010065.

Near-Infrared Spectroscopy (NIRS) versus Hyperspectral Imaging (HSI) to Detect Flap Failure in Reconstructive Surgery: A Systematic Review

Anouk A M A Lindelauf  1 , Alexander G Saelmans  1   2 , Sander M J van Kuijk  3 , René R W J van der Hulst  2 , Rutger M Schols  2
Affiliations
Review

Near-Infrared Spectroscopy (NIRS) versus Hyperspectral Imaging (HSI) to Detect Flap Failure in Reconstructive Surgery: A Systematic Review

Anouk A M A Lindelauf et al. Life (Basel). .

Abstract

Rapid identification of possible vascular compromise in free flap reconstruction to minimize time to reoperation improves achieving free flap salvage. Subjective clinical assessment, often complemented with handheld Doppler, is the golden standard for flap monitoring; but this lacks consistency and may be variable. Non-invasive optical methods such as near-infrared spectroscopy (NIRS) and hyperspectral imaging (HSI) could facilitate objective flap monitoring. A systematic review was conducted to compare NIRS with HSI in detecting vascular compromise in reconstructive flap surgery as compared to standard monitoring. A literature search was performed using PubMed and Embase scientific database in August 2021. Studies were selected by two independent reviewers. Sixteen NIRS and five HSI studies were included. In total, 3662 flap procedures were carried out in 1970 patients using NIRS. Simultaneously; 90 flaps were performed in 90 patients using HSI. HSI and NIRS flap survival were 92.5% (95% CI: 83.3-96.8) and 99.2% (95% CI: 97.8-99.7). Statistically significant differences were observed in flap survival (p = 0.02); flaps returned to OR (p = 0.04); salvage rate (p < 0.01) and partial flap loss rate (p < 0.01). However, no statistically significant difference was observed concerning flaps with vascular crisis (p = 0.39). NIRS and HSI have proven to be reliable; accurate and user-friendly monitoring methods. However, based on the currently available literature, no firm conclusions can be drawn concerning non-invasive monitoring technique superiority.

Keywords: flap failure; flap loss; free flap; hyperspectral imaging; near-infrared spectroscopy; non-invasive monitoring; tissue oxygenation.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure A1
Figure A1
Risk of Bias assessment of the observational studies according to the ROBINS-I.
Figure A2
Figure A2
PRISMA checklist.
Figure 1
Figure 1
Flow chart of the included studies.
Figure 2
Figure 2
Summary of the risk of bias assessment of the included observational studies according to the ROBINS-I.
See this image and copyright information in PMC

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