Evaluating the Effect of Leg Position and Negative Pressure Wound Therapy on Lower Extremity Oxygenation Measured by Noninvasive Tissue Oximetry: A Pilot Study

C. I. Verret, Meridith P. Pollie, Jona Kerluku, S. Dhulipala, D. Fufa
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Abstract

Abstract Background Flap loss is a catastrophic complication following lower extremity reconstructions. Close monitoring can detect circulatory changes, particularly when introducing gravity through dangle protocols. Noninvasive near-infrared spectroscopy (NIRS) tissue oximetry is one such method used for continuous monitoring of tissue perfusion. Recently, negative pressure wound therapy (NPWT) has been for compromised flaps salvage. We used NIRS to study the impact of leg positioning and NPWT on lower extremity perfusion during a mock dangle protocol. Methods A tissue oximeter transcutaneous probe was placed on each lower limb of five normal patients at the location of the highest density of peroneal artery perforators along the distal one-third fibula. The experimental leg probe was covered with NPWT at 100 mm Hg. The contralateral leg served as control. Tissue oxygen saturation (StO2) was measured continuously for 140 minutes. Leg position was changed in every 20 minutes to mimic a dangle protocol. Results Our results showed higher StO2 with leg elevation, and lower StO2 in dependent positions in the control limb. StO2 was consistently higher in the limb with NPWT, which had a slower rate of deoxygenation with introduction of gravity. In both conditions, on returning to neutral position from the dependent, StO2 returned to levels close to baseline. Conclusion These data provide further information on hemodynamic changes introduced by gravity, and how NPWT might modulate these changes.
用无创组织血氧测定法评估下肢体位和负压创伤治疗对下肢氧合的影响:一项初步研究
摘要背景 皮瓣缺失是下肢重建术后的灾难性并发症。密切监测可以检测循环系统的变化,特别是当通过悬挂协议引入重力时。无创近红外光谱(NIRS)组织血氧测定法是用于连续监测组织灌注的一种方法。最近,负压创伤治疗(NPWT)已被用于受损皮瓣的挽救。我们使用NIRS来研究模拟悬吊方案中腿部定位和NPWT对下肢灌注的影响。方法 将组织血氧计经皮探针放置在五名正常患者的每条下肢上,位于腓骨远端三分之一处腓动脉穿支密度最高的位置。实验支腿探针在100 毫米汞柱。对侧腿作为对照。测量组织氧饱和度(StO2) 连续140 分钟腿部位置每20个 几分钟来模仿一个晃来晃去的协议。后果 我们的研究结果显示,随着腿部抬高,StO2升高,对照肢体依赖位置的StO2降低。在NPWT的肢体中,StO2始终较高,随着重力的引入,其脱氧速率较慢。在这两种情况下,当从依赖状态恢复到中性位置时,StO2恢复到接近基线的水平。结论 这些数据提供了关于重力引起的血液动力学变化的进一步信息,以及NPWT如何调节这些变化。
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