Back to 2026 ePosters
Postoperative near-infrared and infrared spectroscopy imaging as early predictors of digital replantation success
Raysa Cabrejo, MD
1, Pooja Yesantharao, MD MS
2, Isabel Robinson, MD
1, Max L Silverstein, MD
3, Robin T Wu, MD
4, Bauback Safa, MD
1; Walter C. Lin, MD
1(1)The Buncke Clinic, San Francisco, CA, (2)Stanford University School of Medicine, Palo Alto, CA, (3)Division of Plastic & Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, (4)Stanford University, Stanford, CA
Introduction: Postoperative management following digital revascularization and replantation requires effective post-operative monitoring and careful decision-making. Thoughtful adjustments are frequently made regarding anticoagulation, medications, leeching, and in some cases reoperation. The survival or failure of challenging digit salvage procedures may be difficult to predict and may require a lengthy hospitalization or outpatient demarcation. This period of uncertainty regarding digit viability may be distressing to the patient and expensive to the healthcare system.
In this study, we present the use of post-operative imaging as an early predictor of eventual digit viability using data acquired via a mobile multispectral near infrared spectroscopy (NIRS) and infrared thermography imaging device. Our goal is to correlate temperature measurements throughout the post-operative course to determine outcomes in a more advanced timeline, which would help determine necessary interventions, guide patient discussions, and decrease overall length of hospital stay.
Materials & Methods: A retrospective case control study was performed of digital replantation and revascularization at a single institution. NIRS and infrared images of the operated and adjacent control digits were taken during the postoperative inpatient stay. Outcomes of eventual digit viability versus revision amputation were recorded. The temperature differential between the injured digit and control digits were evaluated using a logistic regression and area-under-the-curve calculations.
Results: An initial group of 20 replanted and revascularized digits were evaluated with NIRS and thermal imaging during their post-operative course. (Additional prospective data is being collected.) Roughly 25% of digits ultimately required revision amputation. Preliminary statistical analysis demonstrated that temperature differentials between the operated digit and control digits on postoperative (POD) 4-5 could be indicative of overall outcome, AUC 0.91. A logistic regression demonstrated that for every degree difference between the operated digit and a control digit, at POD 4-5 there was an odds ratio of 1.4 for revision amputation (p-value=0.07, nearing significance).
Conclusions: Challenging digit replantations sometimes require an undesirably prolonged hospital admission for digit monitoring and therapy, or require outpatient follow-up and surgery following replantation failure. This duration of uncertainty is both distressing and expensive for the patient and healthcare system. Multispectral thermal imaging of replanted digits may allow for earlier prediction of poor outcomes, providing time for more aggressive interventions, more accurate patient counseling, or earlier decision-making regarding revision amputation, which in turn decreases hospital length of stay and/or the stress of an outpatient waiting period. Please note there is ongoing prospective collection of data.
Back to 2026 ePosters
