Please see Bibliography of References for a list of abstracts, manuscripts and posters.

Other Studies

A prospective trial of near-infrared spectroscopy (NIRS) as a continuous non-invasive method of flap monitoring following breast reconstruction

Cairns SA, Whitaker IS, Barrett MD, Hiew LY, Boyce DE, Cooper MACS, Leaper DJ. The 3rd Congress of the World Union of Wound Healing Societies (WUWHS); June 4-8, 2008; Toronto, Canada.

Goals and Objectives: Flap failure following breast reconstruction incurs significant physical and psychological morbidity. Efficacious post-operative monitoring is mandatory to allow early re-exploration and improved salvage rates. Near Infra-red spectroscopy is a novel technique currently under investigation. There is a paucity of published literature assessing its efficacy.

Purpose: This prospective pilot study investigates the utility of NIRS as an adjunct to clinical monitoring by assessing the specificity and sensitivity of detecting early signs of flap compromise.

Methods: Fifteen patients requiring breast reconstruction following mastectomy were recruited. Using the Inspectra^™ StO₂ monitor (Hutchinson^®), measurements of tissue oxygen saturation (StO₂) and total Haemoglobin Index (THI) were undertaken pre, intra and post-operatively for 72 hours. Patients were nursed in HDU, recording hourly clinical observations of both the flap and patient.

Results: Of the 15 patients, 12 exhibited no significant changes in either their StO₂ or THI. One patient's StO₂ showed a significant downwards trend in the presence of normal clinical examination. In one patient the NIRS probe gave an 'early warning' to impending flap compromise - six hours post-operatively there was an upward trend in the THI, preceding clinical signs of incipient failure by 2 hours. The patient was returned to theatre and the flap was removed after several attempts to revise the venous anastomosis. One other patient's StO₂ declined immediately post-operatively and the flap was pale. The patient was returned to theatre, and the arterial anastomosis was successfully revised. There was partial flap necrosis long term, treated conservatively.

Discussion/Conclusion: Near infrared spectroscopy has great potential in the field of reconstructive surgery, it is a powerful non-invasive flap monitoring tool. This pilot study using the Inspectra^™ StO₂ monitor was welcomed by clinical staff with high patient satisfaction.