Using Near Infrared Spectroscopy as a Guide for Operative Debridement Enhancing Surgical Wound Reconstruction Outcomes

Introduction: Surgical reconstruction of chronic wounds using soft tissue flaps is commonly performed to expedite healing and achieve wound closure.  Several factors have been described that result in a high incidence of failure including reduced tissue perfusion and oxygenation.  Oxygenation is required for proper surgical wound healing.  Near infrared spectroscopy (NIRS) has been used to evaluate tissue oxygen saturation and perfusion, a key indicator of tissue health.Methods:Five complex wound cases were  presented for surgical reconstruction .  Intraoperative NIR imaging was performed in all 5 cases.  In 4 of 5 cases NIR imaging was performed pre and post excisional debridement.  In one case, NIR was used to assess flap perfusion.  Additionally, non contact fluorescence imaging was used pre and post excisional debridement to assess presence and location of pathogenic bacteria.Results:In all 5 cases, NIRS imaging was performed with minimal additional operative time.  The images showed improved perfusion immediately following excisional debridement.  The NIR imaging also confirmed tissue oxygenation of the remaining tissue as well as flap perfusion. Additionally, the NIR images were found to correlate with fluorescent images confirming reduction of bacterial presence and adequacy of excisional debridement of bacteria burdened tissue.  Discussion: NIRS (Snapshot NIR) 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.  NIRS is a technology that has been welcomed by the wound care community partly because of its ease of use. The surgical community may also benefit from the NIR imaging.  The ease of use in the operating room (OR) is an important advantage over technologies previously embraced in the OR setting.  There is no intravascular injection required and the handheld device is user friendly. Additionally, the ability to monitor perfusion and specifically oxygenation throughout management of the wound from clinic to operating room offers a unique advantage for continuity of care.  But most importantly, the assurance of adequate debridement of bacterial burdened and poorly oxygenated tissues improves surgical outcomes.  In all 5 cases, intraoperative NIR imaging was utilized and helped determine the extent of debridement and flap perfusion.  In all cases healing progressed with no post operative infection.  The pressure ulcer surgical reconstructive flaps (n=2) healed without incident.  The VLU, DFU, and non-healing surgical wound of the abdomen are healing secondarily and are anticipated to heal without further surgical intervention.  References:1. Gopalakrishnan S, Niezgoda J, Hoffman B, Siddique S, Niezgoda JA. Using near infrared spectroscopy imaging to manage critical limb ischemia. Today’s Wound Clinic®. 2019;13(9):12-15. 2. Jones GE, King VA, Yoo A, Abu-Ghname A, Rammos CK. Use of New Technologies in Implant-Based Breast Reconstruction. In: Seminars in Plastic Surgery. Vol 33. Thieme Medical Publishers; 2019:258-263. 3. Jones G, Yoo A, King V, Sowa M, Pinson D. A prospective blinded evaluation of Snapshot multispectral imaging and SPY laser fluorescence imaging of flap viability in a rat flap model. Presentation/Abstract presented at: American Society of Plastic Surgeons: The Meeting; Sept 2018. 4. Jones G, Yoo A, Sowa M, King V. Comparison of multispectral reflectance imaging and indocyanine green angiography. Plast Reconstr Surg Glob Open. 2018;10(PSTM 2018 Abstract Supplement):234-235. www.PRSGlobalOpen.com.