Evaluation of Enhanced Tissue Oxygenation and Perfusion using Near Infra-red Spectroscopy with Utilization of Novel Lower Extremity Therapeutic Vascular Device

Introduction:  NIRS (SnapshotNIR, Kent Imaging LLC, Calgary, Canada) is a non-invasive imaging device that can measure oxygenated and de-oxygenated levels of hemoglobin in the wound and periwound tissues to calculate and create an image of tissue oxygen saturation (STO2). The Vascular Boot (Rooke Vascular Boot, Osborn Medical Corporation, Centennial, CO, USA)  is a pressure redistribution boot that provides the additional benefit of increasing lower extremity tissue perfusion. Near infra-red spectroscopy (NIRS) has been used to evaluate tissue oxygen saturation and perfusion.  This study demonstrates enhancement of tissue oxygenation and perfusion using NIRS following application of the vascular boot.Methods:  A patient with compromised lower extremity perfusion was enrolled.  The left lower extremity was treated with the Vascular Boot. The device was applied and maintained for 1 hour. The testing was accomplished with the patient in a seated position with leg elevated.  NIRS imaging (SnapshotNIR) was accomplished prior to and immediately post boot application.  The test subject’s contralateral extremity was used as a control.Results:Results: Comparison of STO2 values between the left leg (test) and right leg (control) demonstrated significant improvement in STO2.  This study demonstrates the effectiveness of the vascular boot in enhancing tissue perfusion by measuring tissue oxygenation using NIRS. Discussion:  The Vascular Boot is a pressure redistribution boot that helps prevent the formation of pressure ulcers with the additional benefit of increasing lower extremity tissue perfusion as shown by fluorescent angiographic imaging. The mechanism of action for increasing tissue perfusion is the unique design of the vascular boot that utilizes synthetic lambswool to naturally warm the limb which leads to an increase in circulation. Pressure ulceration is the result of prolonged pressure over bony prominences of the body resulting in tissue ischemia.  Pressure injury prevention begins with the identification of at-risk patients followed by initiation of care protocols that incorporate careful monitoring and aggressive pressure redistribution protocols including the use of pressure reduction technologies. Prevention of pressure injury and the treatment of patients with pressure ulcers must include the aggressive use of pressure redistribution devices.  Enhancement of tissue perfusion and oxygen clearly correlates with improved clinical outcomes.  This study demonstrates the combined benefit of pressure redistribution and increase tissue perfusion achieved with a single device using NIRS imaging.  Additional studies are indicated to fully understand this synergistic effect and the potential impact on pressure injuries.References: