The utility of near infrared imaging in intra-operative prediction of flap outcome: a reverse McFarlane skin flap model study

Skin flaps are complex procedures used extensively in reconstructive surgery that require post-operative monitoring to ensure that they do not fail. Near infrared (NIR) spectroscopic imaging is a convenient, non-invasive method for surgeons to examine flaps during surgery and in the early post-operative period. Using a reverse McFarlane skin flap model, we show that model-free chemometric methods as well as simple modified Beer-Lambert analysis of the NIR images provide insights into the blood supply to flaps and demonstrate that the technique can detect and localise perfusion-related complications as well as give real-time feedback to the surgeon as they try to resolve the complication. We also show that using estimates of tissue haemoglobin oxygen saturation, imaging measurements made during surgery and in the early post-operative period are highly predictive of the outcome of the flap tissue with specificities and sensitivities exceeding 85%.