A systematic review of near-infrared spectroscopy in flap monitoring: Current basic and clinical evidence and prospects

Background: Near-infrared spectroscopy (NIRS) has been reported to be a reliable non-invasive modality for free flap monitoring; however, the history of its application in flap monitoring is short, and there is no definite consensus regarding its use at present. Objectives: The aim of this review is to clarify the evidence related to post-operative flap monitoring using NIRS and examine its appropriateness and usability. Materials and methods: The PubMed and Web of Science databases were searched using the strings flap monitoring AND near-infrared spectroscopy and flap monitoring AND tissue oxygen saturation, with a study period from inception to December 31, 2016. Two authors independently extracted articles and assessed the quality of the studies. Articles related to NIRS for flap perfusion monitoring were classified and selected regardless of study type. Results: A total of 15 clinical studies and 8 animal studies were identified and reviewed. The evidence and information on various aspects of NIRS flap monitoring were summarized. The overall flap success rate was 99.5%, and the flap salvage rate was 91.1%, when measuring StO(2) at intervals of every 2 h or sooner. Single StO(2) monitoring was able to detect vascular compromise with 99.1% sensitivity and 99.9% specificity, and earlier than other monitoring methods, but additional Hb concentration monitoring was useful for avoiding false negatives and differentiating arterial and venous occlusion. Conclusions: NIRS can be used for flap monitoring and displays high accuracy in various situations; however, further studies are needed to take full advantage of the potential of NIRS. (c) 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.