(CS-055) The initial learning curve of Near Infrared Spectroscopy for the evaluation of periwound perfusion after revascularization

Co-Author(s):

Denise Alabi, BS; Lauren Rodio, BS; Chad Saintsing, BS; John Lantis, MD – Site Chief and Professor, Surgery, Mount Sinai West Hospital and Icahn School of Medi

Introduction:

In limb salvage operations the assessment of adequate reperfusion is a key ingredient.  This reperfusion assessment usually has to occur in the outpatient setting several days after the procedure.  Development of a point of intervention assessment tool is beneficial to the interventionalist, and the wound care specialist, (if they are not the same person).  Near infrared spectroscopy (NIRS) offers the ability to assess the oxygen delivery to the tissue by imaging various components of the patient’s hemoglobin. 

Methods: :  Our initial 12 patients undergoing revascularization both open and endovascular for limb salvage our review.  An IRB protocol was developed that allowed for preoperative imaging of the patient's feet, in four views using a NIRS infrared spectroscopy camera.  Patients were then assessed immediately post procedure, 24 hours post-procedure and 1 week post procedure to evaluate the changes in oxygenated hemoglobin delivery, and oxygen take up in the surrounding tissue.

Results:

All patients had significant improvement in oxygen delivery by 24 hours, many did not have immediate improvement however.  In addition melanin continues to be a challenge in patients with pigmented skin, near infrared spectroscopy in those patients is best utilized from a plantar position.  Postprocedural evaluation is becoming better but is not immediate.  Wounds that were immediately debrided appeared to have a different reperfusion pattern than those that were not

Discussion:

This interesting technology continues to improve and in the long run will most likely be a good adjunct to assess adequacy of revascularization status post procedures.  At the moment the amount of data that is available from the images is significant, and possibly simple find that data will make it easier for practitioners to assess the periwound perfusion.  We intend to follow the 30 patients that will be in this a cohort eventually, and follow their long-term wound closure to get better data in regards to the correlation between the near infrared spectroscopy findings and the actual clinical outcome of the wounds.

Trademarked Items: NIRS - is Snapshot - the device is not mentioned by name

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