Hyperspectral Imaging Allows Evaluation of Free Flaps in Craniomaxillofacial Reconstruction : Journal of Craniofacial Surgery

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Hyperspectral Imaging Allows Evaluation of Free Flaps in Craniomaxillofacial Reconstruction

Thoenissen, Philipp MD, DDS; Heselich, Anja PhD; Al-Maawi, Sarah DDS; Sader, Robert MD, DDS, PhD; Ghanaati, Shahram MD, DDS, PhD

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The Journal of Craniofacial Surgery 34(3):p e212-e216, May 2023. | DOI: 10.1097/SCS.0000000000009009



Treatment of extended defects after tumor resection in oral, maxillofacial, and facial surgery (craniomaxillofacial) is usually performed by free microvascular flaps. Evaluation of flap survival is crucial, especially in the first hours after insertion and connection. For flap evaluation various invasive and noninvasive methods have been developed. This retrospective clinical study examined the ability of a hyperspectral imaging (HSI) camera (Tivita, Diaspective Vision, Germany) to assess postoperative flap properties in comparison to established clinical parameters.

Materials and Methods: 

Thirteen patients with tumor resection and free flap reconstruction were included for camera analysis and another 10 patients as control group. For this purpose, at defined time intervals and under standardized conditions, recordings of transplants 3 to 100 hours postoperatively were performed. Images were used to examine oxygenation (StO2%), tissue hemoglobin index, tissue water index, near infrared range perfusion index of free flaps quantitatively and qualitatively.


HSI provides values differing between patients observed with no intraindividual significant difference. After 24 hours a mean reduction of 16.77% for StO2%, 9.16% for tissue hemoglobin index and 8.46% was observed, going in line with no loss of flap was noted in the observation period.


HSI is suitable as a noninvasive measure for the evaluation of free flaps in craniomaxillofacial surgery in case of stable imaging conditions with respect to light, surrounding and position of the camera. However, clinical measurements are still the method of choice.

Copyright © 2023 by Mutaz B. Habal, MD

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