Use of near infrared spectroscopy and implantable Doppler for postoperative monitoring of free tissue transfer for breast reconstruction: a systematic review and meta-analysis

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Title: Use of near infrared spectroscopy and implantable Doppler for postoperative monitoring of free tissue transfer for breast reconstruction: a systematic review and meta-analysis
Authors: Berthelot, M
Ashcroft, J
Boshier, P
Henry, FP
Hunter, J
Lo, B
Yang, G-Z
Leff, D
Item Type: Journal Article
Abstract: Background: Failure to accurately assess the perfusion of free tissue transfer (FTT) in the early postoperative period may contribute to failure, which is a source of major patient morbidity and healthcare costs. Goal: This systematic review and meta-analysis aims to evaluate and appraise current evidence for the use of nearinfrared spectroscopy (NIRS) and/or implantable Doppler (ID) devices compared with conventional clinical assessment (CCA) for postoperative monitoring of FTT in reconstructive breast surgery. Methods: A systematic literature search was performed in accordance with the PRISMA guidelines. Studies in human subjects published within the last decade relevant to the review question were identified. Meta-analysis using random effects models of FTT failure rate and STARD scoring were then performed on the retrieved publications. Results: 19 studies met the inclusions criteria. For NIRS and ID, the mean sensitivity for the detection of FTT failure is 99.36% and 100% respectively, with average specificity of 99.36% and 97.63% respectively. From studies with sufficient reported data, meta-analysis results demonstrated that both NIRS (OR = 0.09 [0.02, 0.36], P < 0.001) and ID (OR = 0.39 [0.27, 0.95], P = 0.04) were associated with significant reduction of FTT failure rates compared to CCA. Conclusion: The use of ID and NIRS provide equivalent outcomes in detecting FTT failure and were superior to CCA. The ability to acquire continuous objective physiological data regarding tissue perfusion is a perceived advantage of these techniques. Reduced clinical staff workload and minimised hospital costs are also perceived as positive consequences of their use.
Issue Date: 29-Oct-2019
Date of Acceptance: 12-Jul-2019
URI: http://hdl.handle.net/10044/1/71943
DOI: 10.1097/GOX.0000000000002437
ISSN: 2169-7574
Publisher: Lippincott, Williams & Wilkins
Start Page: 1
End Page: 8
Journal / Book Title: Plastic and Reconstructive Surgery Global Open
Volume: 7
Issue: 10
Copyright Statement: © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
Sponsor/Funder: Engineering & Physical Science Research Council (EPSRC)
Engineering and Physical Sciences Research Council
Funder's Grant Number: EP/L014149/1
EP/L014149/1
Publication Status: Published
Online Publication Date: 2019-10-29
Appears in Collections:Faculty of Engineering
Division of Surgery
Computing
Faculty of Medicine



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