DOI: http://dx.doi.org/10.18203/issn.2454-2156.IntJSciRep20200193

Evaluation of a replanted finger and measuring its perfusion changes to predict its viability by laser speckle contrast imaging

Bilkis Akthar, Zeng Tao Wang, Muhsin Billah Bin Khashru, Hou Zhi Dian

Abstract


Background: This research aims to monitor the microcirculation of the replanted finger, which was entirely severed by using laser speckle contrast imaging (LSCI) for early detection and revision of vascular compromise for successful finger replantation.

Methods: These six months of research was taken for a survey of 40 cases of replanted fingers of patients of distinct ages and sex. Scrutinizing was done postoperatively by LSCI, every hourly for seven days, to assess changes in blood perfusion both in replanted fingers and healthy ones and analyzed graphically.  

Results: Initially, from postoperative d=0 to d=2, the perfusion value was at baseline, which ranged 40±15 perfusion unit (PU), showing a wave-like curve, then gradually increased up to 350±50 PU or above in case of those which survived successfully, showing continuous peak slope. However, a gradual drop in perfusion, <35 PU from d=2 or d=3, was seen in those despite undergoing heparinized finger pin-prick bleeding therapy and failed to thrive, showing a downslope curve. Whereas some were under meticulous observation, which flourished lately. Concurrently, a comparison was made with the healthy fingers’ of the same patient, ranging from 200±50 to as high as 400±50 or above. Clinical correlation, as well as perfusion readings of LCSI, were done simultaneously.

Conclusions: LSCI provides sensitive and reproducible finger microcirculation measurements and is reliable in predicting reductions in blood perfusion induced by venous or arterial occlusion. It is, therefore, an informative device to detect microvascular compromise during and after replantation surgery.


Keywords


Replanted finger, Replantation, Laser speckle contrast imaging, Perfusion evaluation, Microcirculation, Predictability

Full Text:

PDF

References


Zötterman J, Tesselaar E, Farnebo S. The use of laser speckle contrast imaging to predict flap necrosis: An experimental study in a porcine flap model. J Plastic Reconstructive Aesthetic Surg. 2019;72(5):771-7

Zötterman J, Bergkvist M, Iredahl F, Tesselaar E, Farnebo S. Monitoring of partial and full venous outflow obstruction in a porcine flap model using laser speckle contrast imaging. J Plastic Reconstructive Aesthetic Surg. 2016;69(7):936-43.

Lindahl F, Tesselaar E, Sjöberg F. Assessing pediatric scald injuries using Laser Speckle Contrast Imaging. Burns. 2013;39(4):662-6.

Ponticorvo A, Rowland R, Baldado M, Burmeister D, Christy RJ, Bernal NP, et al. Evaluating clinical observation versus Spatial Frequency Domain Imaging (SFDI), Laser Speckle Imaging (LSI) and thermal imaging for the assessment of burn department. Burns. 2019;45(2):450-60.

Krishnan NM, Brown BJ, Davison SP, Mauskar N, Mino M, Jordan MH, et al. Reducing Wound Tension with Undermining or Imbrication-Do They Work? Plastic Reconstr Surg Glob Open. 2016;4(7):e799.

Boas DA, Dunn AK. Laser speckle contrast imaging in biomedical optics. J Biomed Opt. 2010;15(1):1-12.

Fercher AF, Briers JD. Flow visualization by means of single-exposure speckle photography, Optics Communications. 1981;37(5):326-30

Briers JD. Laser speckle contrast imaging for measuring blood flow. Optica Applicata. 2007;37:139-52.

Briers D, Duncan DD, Hirst E, Kirkpatrick SJ, Larsson M, Steenbergen W, et al. Laser speckle contrast imaging:theoretical and practical limitations. J Biomed Optics. 2013;18(6):1-10.

Eriksson S, Nilsson J, Lindell G, Sturesson C. Laser speckle contrast imaging for intraoperative assessment of liver microcirculation:a clinical pilot study. Med Devices (Auckl). 2014;7:257-261.

Heeman W, Dijkstra K, Hoff C, Koopal C, Pierre J, Bouma H, et al. Application of laser speckle contrast imaging in laparoscopic surgery. Biomed Opt Express. 2019;10(4):2010-9.

Milstein DMJ, Ince C, Gisbertz SS, Boateng KB, Geerts BF, Hollmann MW, et al. Laser speckle contrast imaging identifies ischemic areas on gastric tube reconstructions following esophagectomy. Medicine (Baltimore). 2016;95(25):e3875.

Wang Z, Hughes S, Dayasundara S, Menon RS. Theoretical and experimental optimization of laser speckle contrast imaging for high specificity to brain microcirculation. J Cereb Blood Flow Metab. 2007;27(2):258-69.

Molnár E, Molnár B, Lohinai Z, Tóth Z, Benyó Z, Hricisák L, et al. Evaluation of Laser Speckle Contrast Imaging for the Assessment of Oral Mucosal Blood Flow following Periodontal Plastic Surgery:An Exploratory Study. Biomed Res Int. 2017;2017:4042902.

Laser Speckle Contrast Analysis. Perimed. Availble at: https://www.perimed-instruments.com/laser-speckle-contrast-analysis. Accessed on 3 June 2019.

Postnov DD, Cheng X, Evren S, Erdener, Boas DA. Choosing a laser for laser speckle contrast imaging. Scientific Reports. 2019;9(1):2542.

Briers JD, Webster SE. Laser speckle contrast analysis (LASCA):a nonscanning, full-field technique for monitoring capillary blood flow. J Biomed Optics. 1996,1 2:174 - 179.

Zötterman J, Mirdell R, Horsten S, Farnebo S, Tesselaar E. Methodological concerns with laser speckle contrast imaging in clinical evaluation of microcirculation. PLoS One. 2017;12(3):e0174703.

Nadort A. Glow with the flow:Quantifying blood flow and photoluminescence signal in biological tissue. Semantic Scholar. 2015: 209

Nadort A, Kalkman K, van Leeuwen TG, Fabe DJ. Quantitative blood flow velocity imaging using laser speckle flowmetry. Scientific Reports. 2016;6:25258.

Karakawa R, Yano T, Yoshimatsu H, Harima M, Kanayama K, Iida T, et al. Use of Laser Speckle Contrast Imaging for Successful Fingertip Replantation. Plast Reconstr Surg Glob Open. 2018;6(9):e1924.

Draijer M, Hondebrink E, van Leeuwen T, Steenbergen W. Review of laser speckle contrast techniques for visualizing tissue perfusion. Lasers Med Sci. 2009;24(4):639-51.

Motamedolshariati SM, Rezaei E, Dahmardehei M. Finger Replantation: A Review of Replantation of Four Fingers in Three Patients. Zahedan J Res Med Sci. 2015;17:e1941.

Shaterian A, Rajaii R, Kanack M, Gregory RD.. Predictors of Digit Survival following Replantation: Quantitative Review and Meta-Analysis. J Hand Microsurg. 2018;10(2):66-73.

Venkatramani H, Sabapathy SR. Fingertip replantation:Technical considerations and outcome analysis of 24 consecutive fingertip replantations. Indian J Plastic Surg. 2011;44(2) 237-45.

Lee JY, Kim HS, Heo ST, Kwon H, Jung SN. Controlled continuous systemic heparinization increases success rate of artery-only anastomosis replantation in single distal digit amputation:A retrospective cohort study. Medicine (Baltimore). 2016;95(26):e3979.

Alfeky H, McArthur P, Helmy Y. Salvaging Digital Replantation and Revascularisation: Efficiency of Heparin Solution Subcutaneous Injection. Surgery Res Pract. Nov 2018;2018:1601738.

Mahé G, Humeau-Heurtier A, Durand S, Leftheriotis G, Abraham P. Assessment of skin microvascular function and dysfunction with laser speckle contrast imaging. Circulation-Cardiovascular Imaging. 2012;5(1):155-63.

Thompson OB, Andrews MK. Tissue perfusion measurements:multiple-exposure laser speckle analysis generates laser Doppler-like spectra. J Biomed Optics. 2010;15(2):027015.