Real-Time Flap Viability Monitoring during Facial Transplantation using SFDI

使用 SFDI 进行面部移植期间实时皮瓣活力监测

• 批准号: 8588307
• 负责人: John V Frangioni
• 金额: $ 61.41万
• 依托单位: BETH ISRAEL DEACONESS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-02-01 至 2015-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8588307
• 关键词: Animal Model; Animals; Biological Markers; Biopsy; Clinical; Collaborations; Complex; Complication; Development; Disease; Ensure; Face; Failure; Family suidae; Feedback; Frequencies; Future; Geometry; Goals; Head and Neck Surgery; Head and neck structure; Health Care Costs; Hospitals; Human; Hydration status; Image; Image-Guided Surgery; Imaging Techniques; Imaging technology; International; Laboratories; Left; Life; Light; Lighting; Lipids; Measurement; Measures; Metabolism; Methods; Metric; Monitor; Operative Surgical Procedures; Optics; Outcome; Oxygen; Oxyhemoglobin; Patients; Perfusion; Phase; Physiologic Monitoring; Physiological; Plastic Surgical Procedures; Plastics; Postoperative Period; Procedures; Process; Pulse Oximetry; Quality of life; Reconstructive Surgical Procedures; Sampling; Sensitivity and Specificity; Skin; Skin Tissue; Speed; Surface; Surgeon; Surgical Flaps; System; Technology; Testing; Time; Tissue Viability; Tissues; Translations; Transplantation; Transplanted tissue; Trauma; Validation; Water; cost; deoxyhemoglobin; facial transplantation; follow-up; imaging modality; improved; indexing; malignant breast neoplasm; new technology; novel; object shape; operation; optical imaging; prevent; public health relevance; reconstruction; skills; standard of care; tissue oxygenation

DESCRIPTION (provided by applicant): With the recent introduction of full-face transplantation, it is more important than ever to ensure survival of a transplanted graft. However, flap viability is currently assessed using only subjective clinical criteria or biopsy. Similarly, the field of head and neck reconstructive surgery is struggling to reduce a total flap loss rate as high as 14%. In addition to overt failures, complication rates range from 21% to 43%, leaving patients with a prolonged stay in the ICU, decreased quality of life, and additional healthcare costs. Every year, over 87,000 patients in the US undergo some type of head and neck reconstruction, and new technology that permits objective, noninvasive assessment of flap viability intraoperatively and postoperatively is desperately needed. The hypothesis guiding this study is that near-infrared (NIR) light interacts deeply with living tissue constituents, namely oxyhemoglobin, deoxyhemoglobin, lipids, and water, providing quantitative measurement of physiological parameters, such as oxygenation, metabolism, and hydration. Such information can be used to monitor facial flap transplant viability intraoperatively and postoperatively, in a noninvasive manner and in real time. State-of-the-art NIR endogenous imaging consists of multispectral spatial frequency domain imaging (SFDI) that can accurately provide quantitative images of tissue constituents over large fields of view. The technology we propose to develop is analogous to pulse oximetry. But, rather than sample a single point of the body with NIR light, it provides a complete image of tissue oxygenation and perfusion over the skin surface, and can even separate the contributions of oxyhemoglobin and deoxyhemoglobin to oxygen saturation. To test whether NIR optical imaging has the potential to monitor facial flap viability, we have assembled a multi-institutional team of experts from image-guided surgery, clinical translation, SFDI, and reconstructive surgery. Dr. Bruce Tromberg at UC Irvine is an international leader in biomedical optics whose laboratory first developed the SFDI technique. Dr. Bernard Lee is an active, board-certified plastic and reconstructive surgeon at BIDMC. Our own team at BIDMC has a long and productive track record in intraoperative NIR imaging, with a particular focus on plastic and reconstructive surgery. By leveraging this strong collaboration of experts, our study aims to solve a longstanding problem in facial reconstructive surgery, namely the noninvasive monitoring of tissue transplants intraoperatively and postoperatively using NIR light. Specific aims include optimization of the SFDI technology to permit real-time imaging (< 1 frame per second) of facial transplants, including correction for the complex geometry of the face, the development of a quantitative optical metric of the transplant status, and validation of the optimized method on large animals approaching the size of humans. Completion of these aims has the potential to revolutionize head and neck surgery, especially facial transplants, by providing critical feedback to surgeons, thus permitting them to identify tissue compromise and prevent complications before they occur.

描述（由申请人提供）：随着最近引入全脸移植，确保移植物的存活比以往任何时候都更加重要。然而，目前仅使用主观临床标准或活检来评估皮瓣活力。同样，头颈重建手术领域正在努力降低高达 14% 的皮瓣总丢失率。除了明显的失败外，并发症发生率从 21% 到 43% 不等，导致患者在 ICU 的住院时间延长，生活质量下降，并产生额外的医疗费用。每年，美国有超过 87,000 名患者接受某种类型的头颈部重建，迫切需要能够在术中和术后客观、无创地评估皮瓣活力的新技术。 指导这项研究的假设是，近红外 (NIR) 光与活组织成分（即氧合血红蛋白、脱氧血红蛋白、脂质和水）深度相互作用，提供生理参数的定量测量，例如氧合、代谢和水合作用。此类信息可用于以无创方式实时监测术中和术后面部皮瓣移植的活力。最先进的近红外内源成像由多光谱空间频域成像 (SFDI) 组成，可以在大视场范围内准确地提供组织成分的定量图像。我们建议开发的技术类似于脉搏血氧测定法。但是，它不是用近红外光对身体的单个点进行采样，而是提供皮肤表面组织氧合和灌注的完整图像，甚至可以分离氧合血红蛋白和脱氧血红蛋白对氧饱和度的贡献。 为了测试近红外光学成像是否具有监测面部皮瓣活力的潜力，我们组建了一个由来自图像引导手术、临床翻译、SFDI 和重建手术的多机构专家组成的团队。加州大学欧文分校的 Bruce Tromberg 博士是生物医学光学领域的国际领导者，他的实验室首先开发了 SFDI 技术。 Bernard Lee 博士是 BIDMC 一位活跃的、经过委员会认证的整形和重建外科医生。我们 BIDMC 的团队在术中 NIR 成像方面拥有长期且富有成效的记录，特别关注整形和重建手术。 通过利用专家的强有力合作，我们的研究旨在解决面部重建手术中长期存在的问题，即使用近红外光对术中和术后组织移植进行无创监测。具体目标包括优化 SFDI 技术，以实现面部移植的实时成像（< 1 帧/秒），包括校正面部复杂的几何形状、开发移植状态的定量光学度量以及验证针对接近人类体型的大型动物的优化方法。完成这些目标有可能彻底改变头颈手术，特别是面部移植，通过向外科医生提供关键反馈，从而使他们能够识别组织受损并在并发症发生之前预防并发症。