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）：随着最近引入全面移植，确保移植移植物存活比以往任何时候都重要。但是，目前仅使用主观临床标准或活检评估皮瓣生存力。同样，头部和颈部重建手术领域正在努力降低总皮瓣损失率高达14％。除了明显的失败外，并发症发生率从21％到43％不等，使患者在ICU中长期停留，生活质量降低以及额外的医疗费用。每年，美国超过87,000名患者都会经历某种类型的头颈部重建，并迫切需要对术后和术后术后襟翼生存能力进行客观的无创评估的新技术。 指导这项研究的假设是，近红外（NIR）的光与活组织成分有着深入的相互作用，即氧血红蛋白，脱氧血红蛋白，脂质和水，提供了对生理参数的定量测量，例如氧合，氧化，代谢和水合。此类信息可用于以无创的方式和实时的方式进行术中和术后术中的面部皮瓣移植能力。最先进的NIR内源性成像由多光谱空间频域成像（SFDI）组成，这些频域成像（SFDI）可以准确地在大型视野上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饱和度。但是，它没有用NIR光对身体的单个点进行样品，而是在皮肤表面上提供了组织氧合和灌注的完整图像，甚至可以将氧气血红蛋白和脱氧血红蛋白对氧饱和度的贡献分开。 为了测试NIR光学成像是否有可能监测面部襟翼生存能力，我们组装了来自图像引导手术，临床翻译，SFDI和重建手术的多机构专家团队。 UC Irvine的Br​​uce Tromberg博士是生物医学光学的国际领导者，其实验室首次开发了SFDI技术。伯纳德·李（Bernard Lee）博士是BIDMC的活跃，经过董事会认证的塑料和重建外科医生。我们自己在BIDMC的团队在术中NIR成像中具有较长且富有成效的往绩，特别关注塑料和重建手术。 通过利用专家的这种强大合作，我们的研究旨在解决面部重建手术中的长期问题，即使用NIR光在术中和术后对组织移植物进行无创的监测。具体目的包括优化SFDI技术，以允许面部移植的实时成像（<1帧每秒），包括校正面部的复杂几何形状，开发移植状态的定量光学指标以及对大型动物接近人类大小的优化方法的验证。这些目标的完成有可能通过向外科医生提供关键的反馈来彻底改变头颈手术，尤其是面部移植物，从而允许他们识别组织妥协并防止并发症发生。