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Case Series/Study

(CS-088) Mobile Multispectral Near-Infrared Spectroscopy for Evidence-Based Skin Graft Flap Case

Thursday, May 16, 2024

7:30 PM – 8:30 PM East Coast USA Time

Karen Cross, MD PhD FRCSC

Introduction: Traumatic surgical reconstruction of the lower extremity has high flap failure rates and high rates of wound dehiscence. The free latissimus dorsi flap is considered a workhorse flap for hardware and soft tissue coverage of the foot given adequate vascularity of the limb. With higher than normal failure rates of flaps and skin grafts in this region, using a multispectral imaging system to gain insights into perfusion and oxygenation could hypothetically aid in point of care treatment to enhance wound healing capacity.

Methods:
A 50 yo female with a large soft tissue defect over the dorsum of foot subsequent to a motor vehicle accident presented to the outpatient wound clinic for a non-healing surgical wound. Her reconstruction consisted of open reduction and internal fixation of metatarsals, a free latissimus dorsi flap and split thickness skin graft. She had a patent posterior tibial and peroneal but the dorsalis pedis was sounded. She presented with a nonhealing surgical site with wounds on the dorsal, lateral and medial aspects of foot and superior to the anterior ankle crease. Images of the defect were acquired with a handheld mobile multispectral near-infrared spectroscopy (NIRS) and thermal imaging device* to provide further information about the cause of the slow to heal surgical wound.

Results:
Insights gained from the imaging device highlighted distinctive characteristics of the latissimus dorsi flap with an overlying meshed skin graft. Observations included irregular tissue oxygenation patterns in the meshed skin graft area with consistent temperature values. The areas of the complete skin graft take had increased oxygenation compared to the meshed zones. In the area of wound breakdown, the tissue oxygenation was adequate to facilitate healing.

Discussion:
The primary aim of this study was to investigate the known complications of a latissimus dorsi free flap with meshed skin graft reconstruction in a lower extremity wound. The NIRS and thermographic images showed adequate tissue oximetry of the wound which point to other causes of a slow to heal surgical dehiscence. In this case the irregular tissue oxygenation in the grafted area could be related to the meshed nature of the graft as the device is measuring muscle not skin hemoglobin or could represent the evolving skin migration between the meshed regions. Insights into the patient's recovery timeline and graft vascularization contribute to a comprehensive understanding of the presented case, providing valuable information for healthcare teams involved in similar scenarios.